Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial.
Bottom Line: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212).Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248).
Affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.Show MeSH
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Mentions: The bar charts in figure 1 show per patient the different cost components as a proportion of the total (unadjusted) costs in each study arm. At both baseline and follow-up, medications accounted for the largest percentage of the total cost in all study arms (prescribing 37%, review 31%, TAU 55%), outpatient hospitalisations for TAU (19%), intervention-related costs for pharmacist prescribing (18%) and primary care costs, excluding pharmacist visit costs, for pharmacist review only (20%). Both pharmacist-led intervention arms were less costly than TAU based on the raw unadjusted mean total costs. The TAU group, however, was also the most costly treatment group observed prerandomisation and this was largely driven by medication costs; this suggests potential imbalances between study arms at baseline (figure 1). Following adjustment for differences in baseline costs and controlling for other baseline patient characteristics (age, sex, marital status, work status, education, income, baseline CPG—intensity and baseline SF-6D) yielded positive incremental mean costs differences for both pharmacist-led interventions relative to TAU: prescribing £77.5 (95% CI −£81.7 to £236.7) and review £54.4 (95% CI −£103.3 to £212.1). In other words, the review and prescribing groups relative to TAU were now more expensive rather than cheaper, relative to usual care. Adjusting for baseline costs were largely responsible for this resulting change which was statistically significant (with a regression coefficient p=0.0000). No other variables reached significance.
Affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.