Combining clinical pharmacy services and diabetes management could improve patient outcomes and lead to cost savings over time, according to a study recently published in Journal of the American Pharmacists Association.
“To help patients better manage multiple chronic conditions, the concept of patient-centered medication therapy management was developed,” Mrinmayee Joshi, BPharm, PhD candidate, from the department of pharmacy systems, outcomes and policy at the University of Illinois Chicago College of Pharmacy, and colleagues wrote. “Pharmacists, frequently considered the most accessible health care providers, play an important role in providing clinical services by applying their expertise in medication therapy and disease state management.”
The study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) versus usual care for individuals with type 2 diabetes, from the perspective of cost-effectiveness.
A cohort simulation Markov model with time-varying mortality was developed using Microsoft Excel for Microsoft 365. The researchers modeled outcomes for male and female subpopulations separately, and a weighted average was calculated for the overall MTMC and usual care cohorts.
Outcomes included total costs, total quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained. A 3% annual discount rate was applied to both cost and effectiveness outcomes, the study said. The life-table method was used to calculate state membership in 1-year cycles over a patient’s lifetime.
Over a lifetime, the pharmacist-led medication therapy management clinic approach resulted in total costs of $160,145 and 6.73 QALYs, compared with $152,806 and 6.65 QALYs for usual care.
The ICER for the clinic was $93,375 per QALY gained, which, according to the authors, suggests it is cost-effective given a willingness-to-pay threshold of $100,000 per QALY.
The researchers performed a scenario analysis, which indicated that incorporating additional complications or reducing the frequency of MTMC visits could lower the ICER. The study found that MTMC costs and hazard ratios for major diabetes complications, including stroke, myocardial infarction, and renal failure, were the most influential factors.
“This study underscores the potential value of implementing pharmacist-led MTM in clinical practice to improve outcomes for patients with type 2 diabetes mellitus,” Joshi and colleagues wrote. “Results from this study can be used to advocate for expansion of clinical pharmacy services and reimbursement to pharmacists for providing clinical care to patients with diabetes.”
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Disclosures: Some authors declared financial ties to drugmakers. See full study for details.
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