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Cost Effectiveness of Advanced Pharmacy Services Provided in the Community and Primary Care Settings: A Systematic Review

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Abstract

Background

Pharmacists working in community and primary care are increasingly developing advanced skills to provide enhanced services, particularly in dealing with minor acute illness. These services can potentially free-up primary care physicians’ time; however, it is not clear whether they are sufficiently cost effective to be recommended for wider provision in the UK.

Objective

The aim of this study was to review published economic evaluations of enhanced pharmacy services in the community and primary care settings.

Methods

We undertook a systematic review of economic evaluations of enhanced pharmacy services to inform NICE guidelines for emergency and acute care. The review protocol was developed and agreed with the guideline committee. The National Health Service Economic Evaluation Database, Health Technology Assessment Database, Health Economic Evaluations Database, MEDLINE and EMBASE were searched in December 2016 and the search was updated in March 2018. Studies were assessed for applicability and methodological quality using the NICE Economic Evaluation Checklist.

Results

Of 3124 records, 13 studies published in 14 papers were included. The studies were conducted in the UK, Spain, The Netherlands, Australia, Italy and Canada. Settings included community pharmacies, primary care/general practice surgeries and patients’ homes. Most of the studies were assessed as partially applicable with potentially serious limitations. Services provided in community and primary care settings were found to be either dominant or cost effective, at a £20,000 per quality-adjusted life-year threshold, compared with usual care. Those delivered in the patient’s home were not found to be cost effective.

Conclusions

Advanced pharmacy services appear to be cost effective when delivered in community and primary care settings, but not in domiciliary settings. Expansion in the provision of these services in community and primary care can be recommended for wider implementation.

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Data Availability Statement

All data extracted for this review are available in this paper, its accompanying online sources, and the NICE guideline NG94 (Chapter 10), freely available online at https://www.nice.org.uk/guidance/ng94/evidence/10.communitybased-pharmacists-pdf-172397464597.

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Acknowledgements

The authors would like to express their sincere thanks to the guideline committee members who contributed to the protocol development and commented on the results, informing the discussion of our findings. Thanks also go to Mr. Joseph Runicles, Information Scientist, for his help in compiling the bibliography. The guideline referred to in this article was produced by the National Guideline Centre (NGC) for NICE. The views expressed in this article are those of the authors and not necessarily those of NICE. All authors, external and internal to the NGC, had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis (National Institute for Health and Care Excellence (2018) Emergency and Acute Medical Care in Over 16s: Service Delivery and Organisation. Available at: https://www.nice.org.uk/guidance/ng94)

Funding

This work was undertaken by the NGC, Royal College of Physicians, London, which received funding from NICE. The funding body (NICE) did not play any direct role in the study design; the collection, analysis, and interpretation of data; writing of the report; or in the decision to submit the article for publication. All researchers involved in this work were independent from the funding body at the time of completing this work.

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Authors and Affiliations

  1. Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Kasr El Aini Street, Cairo, Egypt

    Dalia M. Dawoud

  2. Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada

    Alexander Haines

  3. National Guideline Centre, Royal College of Physicians, London, UK

    David Wonderling, Joanna Ashe & Jennifer Hill

  4. NHS Herts Valleys Clinical Commissioning Group, Hertfordshire, UK

    Mihir Varia

  5. Diabetes, Endocrinology and Acute Internal Medicine, Diabetes Centre, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK

    Philip Dyer

  6. Intensive Care Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    Julian Bion

  7. Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Julian Bion

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  1. Dalia M. Dawoud
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Correspondence to Dalia M. Dawoud.

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Dalia M. Dawoud, Alexander Haines, David Wonderling, Joanna Ashe, Jennifer Hill, Philip Dyer, and Julian Bion have no conflicts of interest to declare. Mihir Varia declares being an employee of NHS Herts Valleys Clinical Commissioning Group and undertaking locum work at community pharmacies.

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Dawoud, D.M., Haines, A., Wonderling, D. et al. Cost Effectiveness of Advanced Pharmacy Services Provided in the Community and Primary Care Settings: A Systematic Review. PharmacoEconomics 37, 1241–1260 (2019). https://doi.org/10.1007/s40273-019-00814-4

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