Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists
Community pharmacists’ scope of practice has been evolving from a traditional dispensing role to providing patient-centered services. Given the constraints in healthcare budget and a need for efficient use of finite resources, decision makers may require convincing evidence of value to recommend these services for public funding. Several economic evaluations have aimed to demonstrate the value of services provided by community pharmacists.
The objective of this study was to systematically review the reporting and methodological quality of full economic evaluations of services provided by community pharmacists.
A literature search was conducted in the bibliographic databases MEDLINE, EMBASE, and the NHS Economic Evaluations Database since their inception to February 2019. Two independent reviewers performed title, abstract, full text screening, and data abstraction and assessed the quality of reporting and methodological approaches using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Quality of Health Economic Studies (QHES) checklists.
Twenty full economic evaluations were included in the review. Most of these studies were conducted in the UK (40%), followed by the USA (35%), Canada (10%), the Netherlands (5%), Thailand (5%), and Australia (5%). The efficacy or effectiveness data were drawn from individual level or cluster randomized trials, or observational studies. About half of these studies (45%) adopted the perspective of the public healthcare system. Four studies used decision analytic modeling. We identified issues in these studies with selection of study population, efficacy or effectiveness data, time horizon, outcomes measured, measurement or resources used and cost estimation, analytical approaches, and handling of uncertainty with study parameters. The quality of reporting and methodological considerations was variable across these studies, with none of the studies adequately fulfilling all 24 items of CHEERS or 16 questions of QHES checklists.
Our findings suggest there are various issues related to the quality of conduct and reporting of economic evaluations of services provided by community pharmacists. Interpretation of these studies should be treated with caution to facilitate decision making in the local context. In an era of scarce resources and demand for evidence-informed decision making, there may be a need for guidance on methodological approaches to assess the value of these services.
CS and DH contributed to the design and conduct of the study, title/abstract screening, full text selection, data extraction, critical appraisal, drafting and critical revision of the manuscript for intellectual content, and approved the final draft submitted for publication.
Compliance with Ethical Standards
The Canadian Pharmacists Association funded the writing of the manuscript.
Conflict of interest
Chiranjeev Sanyal is an employee of the Canadian Pharmacists Association. Don Husereau has received consultancy fees from the Canadian Pharmacists Association.
This study did not involve participation of human subjects; therefore, ethical approval was not required.
Data availability statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current review.
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