Economic Impact of Community Pharmacy Intervention
The Study of Cardiovascular Risk Intervention by Pharmacists, a randomized, controlled trial in over 50 community pharmacies in Alberta and Saskatchewan, Canada, demonstrated that a pharmacist intervention program improved cholesterol risk management in patients at high risk for cardiovascular disease. In a substudy, costs and consequences were analyzed to describe the economic impact of the program. Two perspectives were taken: a government-funded health care system and a pharmacy manager. Costs were reported in 1999 Canadian dollars. Incremental costs to a government payor and community pharmacy manager were $6.40/patient and $21.76/patient, respectively, during the 4-month follow-up period. The community pharmacy manager had an initial investment of $683.50. The change in Framingham risk function for the intervention group from baseline also was reported. The 10-year risk of cardiovascular disease decreased from 17.3% to 16.4% (p<0.0001) during the 4 months. The intervention program in this study led to a significant reduction in cardiovascular risk in the intervention group during the 4-month follow-up period. The incremental cost to provide the program appeared minimal from both government and pharmacy manager perspectives. It is hoped that these results could support negotiations for reimbursement of clinical pharmacy services with payors.
Cardiovascular disease (CVD), the result of coronary atherosclerosis, is the leading cause of death in developed countries. In Canada, CVD accounts for 36% of deaths, primarily from acute myocardial infarction. With one in 10 physician visits, and nearly one in 20 hospitalizations attributed to CVD, management of such patients places a significant burden on the Canadian health care system. In 1993, the direct and indirect costs of CVD in Canada exceeded $7 billion.
Elevated serum cholesterol is a well-known risk factor for CVD. Large-scale epidemiologic studies, such as the Framingham, Multiple Risk Factor Intervention Trial, and Seven Countries studies, established a direct relationship between serum cholesterol level and degree of CVD risk. Numerous randomized, multicenter clinical trials demonstrated that a reduction of serum cholesterol significantly reduces the risk of CVD morbidity and mortality. A survey of the Canadian population aged 18 to 74 years revealed that 46% had a total cholesterol level over 200 mg/dl (5.2 mmol/L) and 15% had low-density lipoprotein (LDL)-cholesterol levels over 160 mg/dl (4.1 mmol/L). Despite the prevalence of this risk factor and the overwhelming evidence to support cholesterol-lowering drugs, management of cholesterol risk remains less than optimal.
Improving the management of cholesterol risk begins with the recognition of patients at high risk for developing CVD and initiation of a stepped-care approach of individualized therapy. Numerous studies demonstrated the efficacy of multidisciplinary programs designed to improve patient outcomes through management of cholesterol risk. These studies enrolled patients who were referred to specialty clinics and health centers dedicated to CVD risk factor management. Accessibility to these settings for the general population is often limited; therefore alternative strategies are required.
Community pharmacists are well positioned to identify and follow patients at high risk for CVD. The recently completed Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP) examined the efficacy of a community pharmacist intervention program on cholesterol risk management. The intervention program consisted of an interview with the community pharmacist to identify cardiovascular risk factors, measurement of total cholesterol and blood pressure, education on risk factor management, and close follow-up. The study was stopped early due to striking benefit in the intervention group. A total of 675 patients were randomly assigned to receive either the intervention program or usual care. After 4 months of follow-up, 58% of patients in the intervention group reached the composite primary end point, demonstrating improvements in cholesterol risk management, compared with 30% in usual care (p<0.0001).
Before implementing an intervention program such as SCRIP into community pharmacies, decision-makers must be able to determine the program's value. To improve the quality of fiscal decision-making, governments and third-party payors are demanding economic evaluations of new health care initiatives. These evaluations are intended to provide information to policy makers faced with the difficult decision of resource allocation. Guidelines are available for design and conduct of economic evaluations of new health care technologies.
Given the striking improvement in cholesterol risk management demonstrated by the community pharmacist intervention in SCRIP, it was necessary to evaluate the economic impact of this program. A substudy identified the incremental costs to provide a program of community pharmacy intervention in cholesterol risk management in view of its clinical benefit.
The Study of Cardiovascular Risk Intervention by Pharmacists, a randomized, controlled trial in over 50 community pharmacies in Alberta and Saskatchewan, Canada, demonstrated that a pharmacist intervention program improved cholesterol risk management in patients at high risk for cardiovascular disease. In a substudy, costs and consequences were analyzed to describe the economic impact of the program. Two perspectives were taken: a government-funded health care system and a pharmacy manager. Costs were reported in 1999 Canadian dollars. Incremental costs to a government payor and community pharmacy manager were $6.40/patient and $21.76/patient, respectively, during the 4-month follow-up period. The community pharmacy manager had an initial investment of $683.50. The change in Framingham risk function for the intervention group from baseline also was reported. The 10-year risk of cardiovascular disease decreased from 17.3% to 16.4% (p<0.0001) during the 4 months. The intervention program in this study led to a significant reduction in cardiovascular risk in the intervention group during the 4-month follow-up period. The incremental cost to provide the program appeared minimal from both government and pharmacy manager perspectives. It is hoped that these results could support negotiations for reimbursement of clinical pharmacy services with payors.
Cardiovascular disease (CVD), the result of coronary atherosclerosis, is the leading cause of death in developed countries. In Canada, CVD accounts for 36% of deaths, primarily from acute myocardial infarction. With one in 10 physician visits, and nearly one in 20 hospitalizations attributed to CVD, management of such patients places a significant burden on the Canadian health care system. In 1993, the direct and indirect costs of CVD in Canada exceeded $7 billion.
Elevated serum cholesterol is a well-known risk factor for CVD. Large-scale epidemiologic studies, such as the Framingham, Multiple Risk Factor Intervention Trial, and Seven Countries studies, established a direct relationship between serum cholesterol level and degree of CVD risk. Numerous randomized, multicenter clinical trials demonstrated that a reduction of serum cholesterol significantly reduces the risk of CVD morbidity and mortality. A survey of the Canadian population aged 18 to 74 years revealed that 46% had a total cholesterol level over 200 mg/dl (5.2 mmol/L) and 15% had low-density lipoprotein (LDL)-cholesterol levels over 160 mg/dl (4.1 mmol/L). Despite the prevalence of this risk factor and the overwhelming evidence to support cholesterol-lowering drugs, management of cholesterol risk remains less than optimal.
Improving the management of cholesterol risk begins with the recognition of patients at high risk for developing CVD and initiation of a stepped-care approach of individualized therapy. Numerous studies demonstrated the efficacy of multidisciplinary programs designed to improve patient outcomes through management of cholesterol risk. These studies enrolled patients who were referred to specialty clinics and health centers dedicated to CVD risk factor management. Accessibility to these settings for the general population is often limited; therefore alternative strategies are required.
Community pharmacists are well positioned to identify and follow patients at high risk for CVD. The recently completed Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP) examined the efficacy of a community pharmacist intervention program on cholesterol risk management. The intervention program consisted of an interview with the community pharmacist to identify cardiovascular risk factors, measurement of total cholesterol and blood pressure, education on risk factor management, and close follow-up. The study was stopped early due to striking benefit in the intervention group. A total of 675 patients were randomly assigned to receive either the intervention program or usual care. After 4 months of follow-up, 58% of patients in the intervention group reached the composite primary end point, demonstrating improvements in cholesterol risk management, compared with 30% in usual care (p<0.0001).
Before implementing an intervention program such as SCRIP into community pharmacies, decision-makers must be able to determine the program's value. To improve the quality of fiscal decision-making, governments and third-party payors are demanding economic evaluations of new health care initiatives. These evaluations are intended to provide information to policy makers faced with the difficult decision of resource allocation. Guidelines are available for design and conduct of economic evaluations of new health care technologies.
Given the striking improvement in cholesterol risk management demonstrated by the community pharmacist intervention in SCRIP, it was necessary to evaluate the economic impact of this program. A substudy identified the incremental costs to provide a program of community pharmacy intervention in cholesterol risk management in view of its clinical benefit.
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