Cost Effectiveness of Support for People Starting a New Medication for a Long-Term Condition Through Community Pharmacies: An Economic Evaluation of the New Medicine Service NMS Compared with Normal PracticeReportar como inadecuado




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PharmacoEconomics

pp 1–19

First Online: 03 August 2017

Abstract

BackgroundThe English community pharmacy New Medicine Service NMS significantly increases patient adherence to medicines, compared with normal practice. We examined the cost effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs.

MethodsWe developed Markov models for diseases targeted by the NMS hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma and antiplatelet regimens to assess the impact of patients’ non-adherence. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted life-year QALY were calculated from the perspective of NHS England, using a lifetime horizon.

ResultsNMS generated a mean of 0.05 95% CI 0.00–0.13 more QALYs per patient, at a mean reduced cost of −£144 95% CI −769 to 73. The NMS dominates normal practice with a probability of 0.78 incremental cost-effectiveness ratio ICER −£3166 per QALY. NMS has a 96.7% probability of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY.

ConclusionsOur study suggests that the NMS increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost.

Trial RegistrationClinicalTrials.gov Trial reference number NCT01635361 http:-clinicaltrials.gov-ct2-show-NCT01635361. Current Controlled trials: Trial reference number ISRCTN 23560818 http:-www.controlled-trials.com-ISRCTN23560818-; DOI 10.1186-ISRCTN23560818. UK Clinical Research Network UKCRN study 12494 http:-public.ukcrn.org.uk-Search-StudyDetail.aspx?StudyID=12494.

FundingDepartment of Health Policy Research Programme.

Electronic supplementary materialThe online version of this article doi:10.1007-s40273-017-0554-9 contains supplementary material, which is available to authorized users.

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