Diabetes care involving pharmacists to prevent CHD: a win-win?

A pharmacist

Previous research has shown that pharmacist involvement in the management of type 2 diabetes can improve HbA1c as well as blood pressure and cholesterol. These models of care may be more costly to deliver, however, compared with conventional primary care.

This economic evaluation looked at the cost-effectiveness of pharmacist management in preventing cardiovascular disease in patients with type 2 diabetes.

Clinical question

In type 2 diabetes, does pharmacist involvement to prevent cardiovascular disease worth the added cost of care?

Methods

This was a retrospective cohort study in which the researchers looked at patient historical patient record data from 2007 to 2010.

They compared the outcomes of patients with type 2 diabetes in normal primary care practice (the control group) with patients who had an “enhanced” care programme.

Patients in the two groups were matched according to known risk factors for cardiovascular disease, such as age, diabetes status and other clinical measures.

This data was used to create an economic model for estimating the costs and effectiveness of the enhanced care group for preventing cardiovascular disease over a ten-year time frame.

Findings

Outcome Standard Care Enhanced care Absolute Risk Reduction
Non-fatal CHD, 1 year 1.2% 0.5% 0.5%
Non-fatal CHD, 10 years 14.8% 9.3% 5.5%

Enhanced care was also found to have benefits for fatal coronary heart disease.

The economic evaluation showed that enhanced care was “dominant”, meaning that it reduced costs as well as improving outcomes.

Comments

  • This is a retrospective study based on outcomes data, so we should be cautious in expecting the same results in other settings.
  • There may have been important differences between the control and enhanced care groups, other than just the pharmacist involvement.  Before applying this research, we need to be clear about the intervention that is being delivered and how it differs from standard practice.
  • If they can be replicated in other settings, these findings are significant, as they offer a means of improving outcomes whilst reducing health care costs.
  • It’s possible that the model was not based on the best available evidence.  Further testing of this model is warranted using other evidence on effectiveness and costs.

Reference

Yu J, Shah BM, Ip EJ, Chan J. A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California. J Manag Care Pharm. 2013 Mar;19(2):102-14.

Share this post: Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+ Share via email

Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

More posts - Website

Follow me here –