Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy

Maria-Isabel Valverde-Merino; Fernando Martinez-Martinez; Leticia Garcia-Mochon; Shalom I Benrimoj; Amaia Malet-Larrea; Beatriz Perez-Escamilla; Maria Jose Zarzuelo; Andrea Torres-Robles; Miguel Angel Gastelurrutia; Raquel Varas-Doval; Tamara Peiro Zorrilla; Victoria Garcia-Cardenas

doi:10.2147/PPA.S330371

Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy

Patient Prefer Adherence. 2021 Oct 24:15:2363-2376. doi: 10.2147/PPA.S330371. eCollection 2021.

Affiliations

¹ Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
² Department of Management of Health Services and Professionals, Andalusian School of Public Health, Granada, Spain.
³ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
⁴ Medicines Information Centre, Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastian, Spain.
⁵ Graduate School of Health, University of Technology Sydney, Sydney, Australia.
⁶ Pharmaceutical Care Services Department, General Pharmaceutical Council of Spain, Madrid, Spain.

Abstract

Background: It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence.

Purpose: To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies.

Materials and methods: The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost-utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost-utility ratio (ICUR) was calculated on the total sample of patients.

Results: A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be €27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of €1,494.82/QALY. In the complete case, the service resulted in an ICUR of €2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost-utility plane. Using a threshold value of €20,000/QALY gained, there is a 99% probability that the intervention is cost-effective.

Conclusion: The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective.

Keywords: chronic disease; community pharmacy services; cost–utility analysis; health-related quality of life; medication adherence; pharmacoeconomics.

Grants and funding

The AdherenciaMED project was supported by the General Pharmaceutical Council of Spain through funds provided by Cinfa Laboratories. The sponsor did not have any role in the design, methods, protocol of the study, data collection and analysis. The provider pharmacists did not receive any remuneration for their participation in the study.