Cost-effectiveness of increasing statin adherence for primary and secondary prevention in community pharmacies

Objectives: Therapy persistence is important to achieve optimal clinical benefits of statin therapy. The aim of this study was to determine the cost-effectiveness of pharmaceutical care in community pharmacies, aimed to increase persistence with statin therapy for both primary and secondary prevention of cardiovascular events (CVEs). Methods: The effectiveness of the Dutch pharmaceutical care program MeMO on improving statin therapy persistence was measured in 500 patients and compared to 502 control patients. Time-investments of the program were also collected. Markov models with lifelong time-horizons were developed to estimate the influence of the program on CVEs: Stroke, myocardial infarction (MI), revascularization and mortality. The efficacy of statins, taken from large clinical trials in primary and secondary prevention, were adjusted for therapy persistence. A Dutch health care provider's perspective was adopted for the analysis and probabilistic sensitivity analyses were performed. Results: Patients in the MeMO program had a lower risk for non-persistence, RR = 0.50 (0.40-0.63), the effect was similar in primary and secondary prevention. In a cohort of 1,000 patients, 60% of whom had a history of CVE, the MeMO program resulted in a reduction of 8 non-fatal strokes 2 fatal strokes, 16 non-fatal MIs, 7 fatal MIs and 14 revascularizations. Additional medication, disease management and intervention costs in the MeMO program were € 375,000; the cost-savings due to reduced CVEs were € 450,000. Thus, the MeMO program resulted in 83 quality-adjusted life-years (QALYs) gained and cost-savings of € 75,000. Clinical benefits and cost-savings were highest in the secondary prevention population. Conclusions: Pharmaceutical care in community pharmacies can improve statin therapy persistence, resulting in more optimal prevention of CVEs. The MeMO program resulted in considerable clinical benefits and overall cost-savings. Persistence and adherence improving programs in community pharmacies may provide good value for money and health care insurers should consider reimbursing these activities in The Netherlands

Cost-effectiveness of increasing bisphosphonates adherence for osteoporosis in community pharmacies

OBJECTIVES: Increasing real-life adherence to bisphosphonates therapy is important to achieve the clinical benefits of reducing fractures reported in randomized clinical trials (RCTs). The aim of this pharmacoeconomic analysis was to determine the cost-effectiveness of a pharmaceutical care intervention program in community pharmacies, aimed to increase bisphosphonates adherence for the prevention of osteoporotic fractures. METHODS: A decision analytical model was constructed with a time horizon of three years, discounting at 4.0% and 1.5% annually for costs and effects, respectively. A Dutch healthcare provider's perspective was adopted. Adherence and efficacy data were gathered from a Dutch pharmaceutical care program in community pharmacies (the MeMO intervention). The association between bisphosphonate adherence and osteoporotic fractures was modelled using Dutch clinical studies. Recent and upcoming reimbursement policy changes in The Netherlands were modelled with a scenario of therapeutic substitution, characterized by drastically lower drug prices. RESULTS: Adherence to bisphosphonates therapy in The Netherlands was 68.3%. The pharmaceutical care intervention program increased bisphosphonates adherence to 83.9% (