Cost-Effectiveness of a Pharmacist-Led Medication Therapy Management Clinic for Management of Type 2 Diabetes.

Autor:	Joshi M; PhD Candidate, Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL., Pham C; Clinical Pharmacist, Department of Pharmacy Service, Jesse Brown VA Medical Center, Chicago, IL, PharmD Candidate, University of Illinois Chicago College of Pharmacy, Chicago, IL., Deng H; PhD Candidate, Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL., Mathew S; Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL., Norton RM; Pharmacy Manager - Ambulatory Clinical Services, Department of Pharmacy , Atrium Health, Charlotte, NC, Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL., Kim K; Assistant Professor, Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL., Touchette DR; Professor, Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL., Tilton JJ; Clinical Associate Professor, Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, 833 South Wood Street Suite 164, Chicago, IL 60612. Electronic address: jtilton@uic.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American Pharmacists Association : JAPhA [J Am Pharm Assoc (2003)] 2024 Sep 23, pp. 102253. Date of Electronic Publication: 2024 Sep 23.
DOI:	10.1016/j.japh.2024.102253
Abstrakt:	Objectives: This study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus (T2DM), from a United States payer perspective. Methods: A cohort simulation Markov model was developed including the effects of diabetes and major complications from diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities, were based on data from electronic health records, and published literature. Outcomes evaluated were lifetime incremental costs, quality adjusted life-years (QALYs), and ratios. Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes and of reduced MTMC visit frequency. Results: Over a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The incremental cost-effectiveness ratio (ICER) of the MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure, with an improvement in glycosylated hemoglobin and systolic blood pressure. Conclusions: The study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term healthcare costs. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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