Therapy by physician-pharmacist combination and economic returns for cancer pain management in China: a cost-effectiveness analysis

Xikui Lu; Lu Zhang; Hangxing Huang; Xiangping Wu; Zhenting Wang; Ling Huang; Jingyang Li; Huimin Yu; Hongyan Zhang; Jian Xiao

doi:10.3389/fphar.2023.1073939

Therapy by physician-pharmacist combination and economic returns for cancer pain management in China: a cost-effectiveness analysis

Front Pharmacol. 2023 Aug 4:14:1073939. doi: 10.3389/fphar.2023.1073939. eCollection 2023.

Authors

Xikui Lu^{1

2

3}, Lu Zhang^{1

2}, Hangxing Huang^{1

2

3}, Xiangping Wu^{1

2

3}, Zhenting Wang^{1

2

3}, Ling Huang^{1

2}, Jingyang Li^{1

2}, Huimin Yu^{1

2}, Hongyan Zhang^{1

4}, Jian Xiao^{1

2}

Affiliations

¹ Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
³ College of Pharmacy, Dali University, Dali, China.
⁴ Department of Pharmacy, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China.

Abstract

Objective: To examine whether joint management of cancer pain by physicians and pharmacists in clinics provides economic advantages from the perspective of the Chinese healthcare system. Methods: From February 2018 to March 2020, 100 patients who visited the joint cancer pain clinic at the Xiangya Hospital of Central South University were included. These patients were randomly assigned to either the control or intervention groups. The control group received regular outpatient services from a physician, while the intervention group received regular outpatient services from a physician and medication education provided by a pharmacist. The study considered various direct costs, including drug expenses, physician-pharmacist outpatient services, adverse event management, consultations, examinations, and readmissions. The outcome indicators considered were the cancer pain control rate and the reduction in pain scores. Decision tree modeling, single-factor sensitivity analysis, and probabilistic sensitivity analysis were performed to evaluate the cost-effectiveness of joint physician-pharmacist outpatient services compared to physician-alone outpatient services. Results: The intervention group showed a significantly higher cancer pain control rate than the control group (0.69 vs. 0.39, p = 0.03). In the decision tree model, the intervention group had a significantly lower pain score than the control group (0.23 vs. 0.14). The cost per person in the intervention group was $165.39, while it was $191.1 per person in the control group. The univariate sensitivity analysis showed that the cost of self-management for patients in the control group was identified as the primary sensitivity factor. Probabilistic sensitivity analysis indicated that the joint clinic group had a favorable incremental cost-effectiveness compared to the physician clinic group. In addition, the probabilistic sensitivity analysis demonstrated an absolute advantage in the incremental cost-effectiveness of the joint clinic group over the outpatient physician group. Conclusion: The participation of pharmacists in joint cancer pain clinic services led to improved pain management for patients, demonstrating a clear advantage in terms of cost-effectiveness.

Keywords: cancer pain; cost-effectiveness analysis; decision trees; economics; physician-pharmacist.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was supported by Hunan Provincial Natural Science Foundation of 2021 (2021JJ31043); Changsha Natural Science Foundation of 2020 (kq2007039); 2020 National Geriatric Disease Clinical Medicine Research Center Appropriate Technology Promotion Project (XYYYJSTG-15); Parallel and Distributed Processing for the Stable Support Project of the National Defense Science and Technology Key Laboratory (WDZC20205500121); Key Research Project of Ningxia Hui Autonomous Region in 2021 (Major Project) (2021BEG01001); Degree & Postgraduate Education Reform Project of Central South University (2022JGB067).