The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines
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Objective This “proof of concept” study aimed to assess the cost effectiveness of pharmacists giving advice via telephone, to patients receiving a new medicine for a chronic condition, in England. Methods The self-regulatory model (SRM) theory was used to guide development of our intervention and used in training pharmacists to adopt a patient-centred approach. Non-adherence to new medicines for chronic conditions develops rapidly so we developed a study intervention in which a pharmacist telephoned patients two weeks after they had started a new medicine for a chronic condition. Patients were included if they were 75 or older, or were suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis, and were randomized into treatment or control arms. Main outcome measures were non-adherence and cost to the UK NHS, obtained via a questionnaire sent two months after starting therapy. Cost of the intervention was also included. Incremental cost effectiveness ratios (ICERs) were generated. Results Five hundred patients were recruited. At 4-week follow-up, non-adherence was significantly lower in the intervention group (9% vs 16%, p = 0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control, (23% vs 34% p = 0.021). Mean total patient costs at 2-month follow-up (median, range) were intervention: £187.7 (40.6, 4.2–2484.3); control: £282.8 (42, 0–3804) (p < 0.0001). The intervention was dominant (less costly and more effective). If the decision maker is not willing to pay anything for one extra adherent patient, there is still a 90% probability that the intervention is cost effective. Conclusions These findings suggest that pharmacists can meet patients’ needs for information and advice on medicines, soon after starting treatment. While a larger trial is needed to confirm that the effect is real and sustained, these initial findings suggest the study intervention may be effective, at least in the short term, with a reduced overall cost to the health provider.
KeywordsPatient adherence Economic evaluation Randomised controlled trial Pharmacist England Telephone service
We would like to thank the many who helped us: Intervention pharmacists: Helen Smurthwaite, Glen Savage. Expert panel: Imogen Savage, Mike Schachter, Colin Bradley, John Benson. Statistical advice: Colin Chalmers. Financial support This work was funded by the DHSC London Research & Development, Responsive Funding Programme. The expressed views in the publication are those of the authors and not necessarily those of the NHS or the Department of Health. Conflicts of interest The author have not reported any conflicts of interest.
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