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.

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  1. 1.

    Tsuyuki RT, Houle SKD, Okada H. Time to give up on expanded scope of practice. Can Pharm J. 2018.

    Article  Google Scholar 

  2. 2.

    Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists’ practice: implications for physicians. CMAJ. 2013;185:1228–32.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Dolovich L, Austin Z, Waite N, Chang F, Farrell B, Grindrod K, et al. Pharmacy in the 21st century: enhancing the impact of the profession of pharmacy on people’s lives in the context of health care trends, evidence and policies. Can Pharm J (Ott). 2019;152:45–53.

    Article  Google Scholar 

  4. 4.

    Flowerdew L, Brown R, Russ S, Vincent C, Woloshynowych M. Teams under pressure in the emergency department: an interview study. Emerg Med J. 2012;29:e2.

    Article  PubMed  Google Scholar 

  5. 5.

    Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 4th ed. New York: Oxford University Press; 2015.

    Google Scholar 

  6. 6.

    Sanyal C, Husereau D. Community-based services by pharmacists: a systematic review of cost-utility analyses. Value in Health. 2019.

    Article  PubMed  Google Scholar 

  7. 7.

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. BMC Med. 2013;11:80.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Chiou C-F, Hay JW, Wallace JF, Bloom BS, Neumann PJ, Sullivan SD, et al. Development and validation of a grading system for the quality of cost-effectiveness studies. Med Care. 2003;41:32–44.

    Article  PubMed  Google Scholar 

  10. 10.

    Walker DG, Wilson RF, Sharma R, Bridges J, Niessen L, Bass EB, et al. Best practices for conducting economic evaluations in health care: a systematic review of quality assessment tools. Rockville: Agency for Healthcare Research and Quality (US); 2012.

    Google Scholar 

  11. 11.

    Spiegel BMR, Targownik LE, Kanwal F, Derosa V, Dulai GS, Gralnek IM, et al. The quality of published health economic analyses in digestive diseases: a systematic review and quantitative appraisal. Gastroenterology. 2004;127:403–11.

    Article  Google Scholar 

  12. 12.

    Avery AJ, Rodgers S, Cantrill JA, Armstrong S, Cresswell K, Eden M, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012;379:1310–9.

    Article  PubMed  Google Scholar 

  13. 13.

    Bosmans JE, Brook OH, van Hout HP, de Bruijne MC, Nieuwenhuyse H, Bouter LM, et al. Cost effectiveness of a pharmacy-based coaching programme to improve adherence to antidepressants. Pharmacoeconomics. 2007;25:25–37.

    Article  Google Scholar 

  14. 14.

    Csikar JI, Douglas GV, Pavitt S, Hulme C. The cost-effectiveness of smoking cessation services provided by general dental practice, general medical practice, pharmacy and NHS Stop Smoking Services in the North of England. Community Dent Oral Epidemiol. 2016;44:119–27.

    Article  PubMed  Google Scholar 

  15. 15.

    Elliott RA, Barber N, Clifford S, Horne R, Hartley E. The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Pharm World Sci. 2008;30:17–23.

    Article  PubMed  Google Scholar 

  16. 16.

    Hendrie D, Miller TR, Woodman RJ, Hoti K, Hughes J. Cost-effectiveness of reducing glycaemic episodes through community pharmacy management of patients with type 2 diabetes mellitus. J Prim Prev. 2014;35:439–49.

    Article  PubMed  Google Scholar 

  17. 17.

    Shireman TI, Svarstad BL. Cost-effectiveness of Wisconsin TEAM model for improving adherence and hypertension control in black patients. J Am Pharm Assoc. 2003;2016(56):389–96.

    Article  Google Scholar 

  18. 18.

    Simpson SH, Lier DA, Majumdar SR, Tsuyuki RT, Lewanczuk RZ, Spooner R, et al. Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial. Diabet Med. 2015;32:899–906.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Sinclair HK, Silcock J, Bond CM, Lennox AS, Winfield AJ. The cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking. Int J Pharm Pract. 1999;7:107–12.

    Article  Google Scholar 

  20. 20.

    Thavorn K, Chaiyakunapruk N. A cost-effectiveness analysis of a community pharmacist-based smoking cessation programme in Thailand. Tob Control. 2008;17:177–82.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Tran MT, Holdford DA, Kennedy DT, Small RE. Modeling the cost-effectiveness of a smoking-cessation program in a community pharmacy practice. Pharmacotherapy. 2002;22:1623–31.

    Article  Google Scholar 

  22. 22.

    Akinbosoye OE, Taitel MS, Grana J, Hill J, Wade RL. Improving medication adherence and health care outcomes in a commercial population through a community pharmacy. Popul Health Manag. 2016;19:454–61.

    Article  Google Scholar 

  23. 23.

    Crealey GE, McElnay JC, Maguire TA, O’Neill C. Costs and effects associated with a community pharmacy-based smoking-cessation programme. Pharmacoeconomics. 1998;14:323–33.

    CAS  Article  Google Scholar 

  24. 24.

    Desborough JA, Sach T, Bhattacharya D, Holland RC, Wright DJ. A cost-consequences analysis of an adherence focused pharmacist-led medication review service. Int J Pharm Pract. 2012;20:41–9.

    Article  PubMed  Google Scholar 

  25. 25.

    Marciante KD, Gardner JS, Veenstra DL, Sullivan SD. Modeling the cost and outcomes of pharmacist-prescribed emergency contraception. Am J Public Health. 2001;91:1443–5.

    CAS  Article  Google Scholar 

  26. 26.

    Munroe WP, Kunz K, Dalmady-Israel C, Potter L, Schonfeld WH. Economic evaluation of pharmacist involvement in disease management in a community pharmacy setting. Clin Ther. 1997;19:113–23.

    CAS  Article  Google Scholar 

  27. 27.

    Rashed SM, Goldstein S, Tolley EA, Wilson-Relyea BJ. Cost outcomes of diabetes education in a specialized community pharmacy. Am J Pharm Benef. 2010;2:421–8.

    Google Scholar 

  28. 28.

    Rodriguez de Bittner M, Chirikov VV, Breunig IM, Zaghab RW, Shaya FT. Clinical effectiveness and cost savings in diabetes care, supported by pharmacist counselling. J Am Pharm Assoc (2003). 2017;57:102.e4–108.e4.

    Article  Google Scholar 

  29. 29.

    Wright D, Twigg M, Thornley T. Chronic obstructive pulmonary disease case finding by community pharmacists: a potential cost-effective public health intervention. Int J Pharm Pract. 2015;23:83–5.

    Article  PubMed  Google Scholar 

  30. 30.

    Cote I, Gregoire JP, Moisan J, Chabot I, Lacroix G. A pharmacy-based health promotion programme in hypertension: cost-benefit analysis. Pharmacoeconomics. 2003;21:415–28.

    Article  Google Scholar 

  31. 31.

    Scott A, Tinelli M, Bond C, Community Pharmacy Medicines Management Evaluation T. Costs of a community pharmacist-led medicines management service for patients with coronary heart disease in England: healthcare system and patient perspectives. Pharmacoeconomics. 2007;25:397–411.

    Article  Google Scholar 

  32. 32.

    Moullin JC, Sabater-Hernandez D, Fernandez-Llimos F, Benrimoj SI. Defining professional pharmacy services in community pharmacy. Res Soc Adm Pharm. 2013;9:989–95.

    Article  Google Scholar 

  33. 33.

    Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

    Article  PubMed  Google Scholar 

  34. 34.

    Delgado-Rodriguez M, Llorca J. Bias. J Epidemiol Community Health. 2004;58:635–41.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Schneeweiss S, Avorn J. A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol. 2005;58:323–37.

    Article  PubMed  Google Scholar 

  36. 36.

    Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Ho AMH, Phelan R, Mizubuti GB, Murdoch JAC, Wickett S, Ho AK, et al. Bias in before–after studies: narrative overview for anesthesiologists. Anesth Analg. 2018;126:1755–62.

    Article  PubMed  Google Scholar 

  38. 38.

    Morton V, Torgerson DJ. Effect of regression to the mean on decision making in health care. BMJ. 2003;326:1083–4.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67:267–77.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Briggs A, Sculpher M, Claxton K. Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.

    Google Scholar 

  41. 41.

    Morrison A, Polisena J, Husereau D, Moulton K, Clark M, Fiander M, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012;28:138–44.

    Article  PubMed  Google Scholar 

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Author information




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.

Corresponding author

Correspondence to Chiranjeev Sanyal.

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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.

Ethical approval

This study did not involve participation of human subjects; therefore, ethical approval was not required.

Informed consent

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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Sanyal, C., Husereau, D. Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists. Appl Health Econ Health Policy 18, 375–392 (2020).

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