Costing and description of direct costs.

<p>Costing and description of direct costs.</p

Cost effectiveness ratio and incremental cost effectiveness ratio analysis per year and period considering the cost of embedded pharmaceutical care in the cost of the public health system with assistance to hypertensive patients.

<p>Cost effectiveness ratio and incremental cost effectiveness ratio analysis per year and period considering the cost of embedded pharmaceutical care in the cost of the public health system with assistance to hypertensive patients.</p

Analysis of the one-way sensitivity performed by the incremental net benefit to pharmaceutical care.

<p>INB = Incremental net-benefit. A) Structuring the sensitivity analysis of the incremental net benefit to pharmaceutical care, considering the minimum value of 1 dollar and maximum of 3 x GDP per capita of Brazil used as threshold for the willingness to pay for pharmaceutical care; B) Sensitivity analysis for the incremental net benefit to pharmaceutical care, considering the spending with pharmaceutical care as the willingness to pay for pharmaceutical care after discharge of patients. The maximum value used as a threshold for willingness to pay was the cost of pharmaceutical care calculated in this study. Negative INB values represent a non-compensatory valuation of PC for investment, and positive INB values represent valuation that is compensatory as investment.</p

Monte Carlo simulation sensitivity analysis for the ratio of cost effectiveness and the ratio of incremental cost effectiveness in the period.

<p>Pre-PC period = baseline; <b>A)</b> Monte Carlo simulation sensitivity analysis for ratio of cost effectiveness of pharmaceutical care compared to baseline; <b>B)</b> Monte Carlo simulation sensitivity analysis for ratio of incremental cost effectiveness of pharmaceutical care compared to baseline; <b>C)</b> Sensitivity analysis by Monte Carlo simulation for ratio of cost effectiveness post pharmaceutical care compared to baseline; <b>D)</b> Sensitivity analysis by Monte Carlo simulation for ratio of incremental cost effectiveness for post pharmaceutical care compared to baseline. 10,000 iterations were performed in Monte Carlo simulation to evaluate the variation of the values of the ratio of cost effectiveness and the ratio of incremental cost effectiveness on the variation of costs by pertinent patient to the probability distribution of costs and pressure control percentage of outcome for each baseline year, for the year of pharmaceutical care, and each year after pharmaceutical care. It can be highlighted that after pharmaceutical care there is not the cost of pharmaceutical care for the calculation of the ratios, thus, the ratios reflect the conventional cost for the care of hypertensive patients’ health in the Public Health System as baseline, compared to the result of pharmaceutical care on conventional health costs. Monte Carlo simulations for CER were structured to represent the probability of CER in the PC and post-PC periods being greater than the baseline CER, thus part <b>A)</b> reflects the result of CER difference of the PC period minus the baseline CER period and part <b>C)</b> reflects the result of the difference of the post-PC CER period minus the baseline CER period.</p

Cost-effectiveness plan.

<p>A) Cost-effectiveness plan of pharmaceutical care for years; B) Cost-effectiveness plan of pharmaceutical care for period. By period the mean cost and pressure control percentage of their years was used to compare periods of pharmaceutical care and post pharmaceutical care with the pre-pharmaceutical care period.</p

Cost-consequence analysis of Pharmaceutical Care program for systemic arterial hypertension in the public health system in Brazil

<div><p>ABSTRACT In Brazil, 80% of hypertensive patients have no blood pressure controlled, this fact has caused severe financial consequences for the public health system (PHS) and the Pharmaceutical Care (PC) has emerged as an effective alternative. The aim of this study was to analyze the costs and outcomes of systemic arterial hypertension (SAH) for conventional assistance compared to assistance with PC in the PHS. This is a pharmacoeconomic study with cost-consequence analysis nested to clinical trial. Hypertensives patients were followed-up from 2006 to 2012. During 2009 they were assisted by the PC program in Ribeirão Preto-SP, Brazil. Clinical indicators, systolic and diastolic blood pressure (SBP and DBP), triglycerides, total cholesterol (TC) and its fractions and healthcare indicators, consumption of antihypertensive medication and consultations were analyzed. Costs were listed as direct medical and direct non-medical. The average cost of conventional care for 104 patients followed-up was US$198.97, in the PC period and after discharge was US$ 407.91 and US$ 214.96 patient/year. After discharge of patients from PC there was reduction of SBP, DBP, TC and cardiovascular risk, 9.4 mmHg, 4.6 mmHg, 12.0 mg/dL, and 23% [p<0.005], respectively. The PC program optimized clinical and healthcare indicators and impacted in the SAH costs for the PHS.</p></div

Profile of hypertensive patients at the start of the Pharmaceutical Care.

<p>Profile of hypertensive patients at the start of the Pharmaceutical Care.</p

Percentage of average annual coronary risk calculated by the Framingham Risk Scale over the seven year follow-up of hypertensive patients.

<p>* p value <0.05 compared with the 2008 year.</p

Proportion of patients with satisfactory outcomes for the three periods of analysis of the results.

<p>Proportion of patients with satisfactory outcomes for the three periods of analysis of the results.</p

Flowchart of the stratified sample size for each variable analyzed.

<p>AD = Antihypertensive Drug; PHS = Public Health System; LDL = Low Density Lipoprotein; HDL = High Density Lipoprotein.</p