Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions

Main Article Content


Technology Assessment, Biomedical, Economics, Pharmaceutical, Cost-Benefit Analysis, Quality-Adjusted Life Years, Health Expenditures, Decision Making, Decision Trees, Treatment Outcome, Pharmaceutical Services


In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists’ roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies – including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models’ perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks.

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1. Steed L, Sohanpal R, Todd A, et al. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev. 2019;12(12):CD011207.
2. Touchette DR, Doloresco F, Suda KJ, et al. Economic evaluations of clinical pharmacy services: 2006-2010. Pharmacotherapy. 2014;34(8):771-793.
3. Tonin FS, Wiecek E, Torres-Robles A, et al. An innovative and comprehensive technique to evaluate different measures of medication adherence: The network meta-analysis. Res Social Adm Pharm. 2019;15(4):358-365.
4. Elliott RA, Putman K, Davies J, Annemans L. A review of the methodological challenges in assessing the cost effectiveness of pharmacist interventions. Pharmacoeconomics. 2014;32(12):1185-1199.
5. Perez A, Doloresco F, Hoffman JM, et al. ACCP: economic evaluations of clinical pharmacy services: 2001-2005. Pharmacotherapy. 2009;29(1):128.
6. Newman TV, San-Juan-Rodriguez A, Parekh N, et al. Impact of community pharmacist-led interventions in chronic disease management on clinical, utilization, and economic outcomes: An umbrella review. Res Social Adm Pharm. 2020;16(9):1155-1165.
7. De Rijdt T, Willems L, Simoens S. Economic effects of clinical pharmacy interventions: a literature review. Am J Health Syst Pharm. 2008;65(12):1161-1172.
8. Schumock GT, Butler MG, Meek PD, et al. Evidence of the economic benefit of clinical pharmacy services: 1996-2000. Pharmacotherapy. 2003;23(1):113-132.
9. Chisholm-Burns MA, Graff Zivin JS, Lee JK, et al. Economic effects of pharmacists on health outcomes in the United States: A systematic review. Am J Health Syst Pharm. 2010;67(19):1624-1634.
10. Shafie AA, Hassali MA. Willingness to pay for a pharmacist's dispensing service: a cross-sectional pilot study in the state of Penang, Malaysia. Pharm Pract (Granada). 2010;8(2):116-121.
11. Saokaew S, Maphanta S, Thangsomboon P. Impact of pharmacist's interventions on cost of drug therapy in intensive care unit. Pharm Pract (Granada). 2009;7(2):81-87.
12. Abrahamsen B, Hansen RN, Rossing C. For which patient subgroups are there positive outcomes from a medication review? A systematic review. Pharm Pract (Granada). 2020;18(4):1976.
13. Kosari S, Deeks LS, Naunton M, et al. Funding pharmacists in general practice: A feasibility study to inform the design of future economic evaluations. Res Social Adm Pharm. 2020;[Ahead of Print].
14. Rubio-Valera M, Bosmans J, Fernández A, et al. Cost-effectiveness of a community pharmacist intervention in patients with depression: a randomized controlled trial (PRODEFAR Study). PLoS One. 2013;8(8):e70588.
15. Walley T, Haycox A. Pharmacoeconomics: basic concepts and terminology. Br J Clin Pharmacol. 1997;43(4):343-348.
16. McIntosh E, Luengo-Fernandez R. Economic evaluation. Part 1: Introduction to the concepts of economic evaluation in health care. J Fam Plann Reprod Health Care. 2006;32(2):107-112.
17. Murphy EM, Rodis JL, Mann HJ. Three ways to advocate for the economic value of the pharmacist in health care. J Am Pharm Assoc (2003). 2020;60(6):e116-e124.
18. Pontinha VM, Wagner TD, Holdford DA. Point-of-care testing in pharmacies - An evaluation of the service from the lens of resource-based theory of competitive advantage. J Am Pharm Assoc (2003). 2020;[Ahead of Print].
19. Husereau D, Drummond M, Petrou S, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health. 2013;16(2):e1-e5.
20. Danzon PM, Drummond MF, Towse A, Pauly MV. Objectives, Budgets, Thresholds, and Opportunity Costs-A Health Economics Approach: An ISPOR Special Task Force Report [4]. Value Health. 2018;21(2):140-145.
21. Brouwer WB, Culyer AJ, van Exel NJ, Rutten FF. Welfarism vs. extra-welfarism. J Health Econ. 2008;27(2):325-338.
22. Gyrd-Hansen D. Willingness to pay for a QALY: theoretical and methodological issues. Pharmacoeconomics. 2005;23(5):423-432.
23. Brazier J, Ara R, Azzabi I, et al. Identification, Review, and Use of Health State Utilities in Cost-Effectiveness Models: An ISPOR Good Practices for Outcomes Research Task Force Report. Value Health. 2019;22(3):267-275.
24. Torrance GW, Feeny D. Utilities and quality-adjusted life years. Int J Technol Assess Health Care. 1989;5(4):559-575.
25. Berger M. Willingness to pay versus willingness to buy: what defines value in healthcare?. Value Health. 1998;1(4):201-203.
26. Clement FM, Harris A, Li JJ, Yong K, Lee KM, Manns BJ. Using effectiveness and cost-effectiveness to make drug coverage decisions: a comparison of Britain, Australia, and Canada. JAMA. 2009;302(13):1437-1443.
27. Schwarzer R, Rochau U, Saverno K, et al. Systematic overview of cost-effectiveness thresholds in ten countries across four continents. J Comp Eff Res. 2015;4(5):485-504.
28. Woods B, Revill P, Sculpher M, Claxton K. Country-Level Cost-Effectiveness Thresholds: Initial Estimates and the Need for Further Research. Value Health. 2016;19(8):929-935.
29. Garrison LP Jr, Neumann PJ, Willke RJ, et al. A Health Economics Approach to US Value Assessment Frameworks-Summary and Recommendations of the ISPOR Special Task Force Report [7]. Value Health. 2018;21(2):161-165.
30. Stahl JE. Modelling methods for pharmacoeconomics and health technology assessment: an overview and guide. Pharmacoeconomics. 2008;26(2):131-148.
31. Wang Y, Yeo QQ, Ko Y. Economic evaluations of pharmacist-managed services in people with diabetes mellitus: a systematic review. Diabet Med. 2016;33(4):421-427.
32. Cohen V, Jellinek SP, Hatch A, Motov S. Effect of clinical pharmacists on care in the emergency department: a systematic review. Am J Health Syst Pharm. 2009;66(15):1353-1361.
33. Basu A, Maciejewski ML. Choosing a Time Horizon in Cost and Cost-effectiveness Analyses. JAMA. 2019;321(11):1096-1097.
34. Kim DD, Wilkinson CL, Pope EF, Chambers JD, Cohen JT, Neumann PJ. The influence of time horizon on results of cost-effectiveness analyses. Expert Rev Pharmacoecon Outcomes Res. 2017;17(6):615-623.
35. Westra TA, Parouty MB, Wilschut JC, Boersma C, Postma MJ. Practical implications of differential discounting of costs and health effects in cost-effectiveness analysis. Value Health. 2011;14(8):1173-1175.
36. Hay JW. Economic modeling and sensitivity analysis. Value Health. 1998;1(3):187-193.
37. Annemans L, Genesté B, Jolain B. Early modelling for assessing health and economic outcomes of drug therapy. Value Health. 2000;3(6):427-434.
38. Epstein D, Sutton A. Modelling correlated clinical outcomes in health technology appraisal. Value Health. 2011;14(6):793-799.
39. Boshuizen HC, van Baal PH. Probabilistic sensitivity analysis: be a Bayesian. Value Health. 2009;12(8):1210-1214.
40. Greenberg D, Mohamed Ibrahim MIB, Boncz I. What Are the Challenges in Conducting Cost-of-Illness Studies?. Value Health Reg Issues. 2014;4:115-116.
41. Onukwugha E, McRae J, Kravetz A, Varga S, Khairnar R, Mullins CD. Cost-of-Illness Studies: An Updated Review of Current Methods. Pharmacoeconomics. 2016;34(1):43-58.
42. Rabarison KM, Bish CL, Massoudi MS, Giles WH. Economic Evaluation Enhances Public Health Decision Making. Front Public Health. 2015;3:164.
43. Sullivan SD, Mauskopf JA, Augustovski F, et al. Budget impact analysis-principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health. 2014;17(1):5-14.
44. Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94(12):925-930.
45. Ademi Z, Kim H, Zomer E, Reid CM, Hollingsworth B, Liew D. Overview of pharmacoeconomic modelling methods. Br J Clin Pharmacol. 2013;75(4):944-950.
46. Zhang X. Application of discrete event simulation in health care: a systematic review. BMC Health Serv Res. 2018;18(1):687.
47. Zeater S, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. A model for the financial assessment of professional services in community pharmacy: A systematic review. J Am Pharm Assoc (2003). 2019;59(1):108-116.
48. Houle SKD, Carter CA, Tsuyuki RT, Grindrod KA. Remunerated patient care services and injections by pharmacists: An international update. Can Pharm J (Ott). 2019;152(2):92-108.
49. Urick BY, Urmie JM. Framework for assessing pharmacy value. Res Social Adm Pharm. 2019;15(11):1326-1337.
50. Jackson J, Urick B. Performance-based pharmacy payment models: the case for change. Aust Health Rev. 2019;43(5):502-507.
51. George B, Silcock J. Economic evaluation of pharmacy services--fact or fiction?. Pharm World Sci. 1999;21(4):147-151.

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