EARLY ECONOMIC EVALUATION OF A PHARMACIST-LED INTERVENTION TO IMPROVE MEDICATION USE IN PATIENTS WITH CHRONIC HEART FAILURE
Author(s)
Farzaneh Farzaneh, BSc1, Steef Konings, PhD1, Oskar Rachwal, Msc1, Isaac Corro Ramos, MSc, PhD2, Talitha Feenstra, MSc, PhD3.
1University of Groningen, Groningen, Netherlands, 2Erasmus University, Rotterdam, Netherlands, 3Groningen University/RIVM, Eelderwolde, Netherlands.
1University of Groningen, Groningen, Netherlands, 2Erasmus University, Rotterdam, Netherlands, 3Groningen University/RIVM, Eelderwolde, Netherlands.
OBJECTIVES: The COHESION consortium aims to develop a long-term, personalised pharmacist-led intervention (PhLi) for chronic heart failure (CHF) patients to optimise medication management, with a focus on guideline-directed medical therapy. This study presents an early economic evaluation to assess the cost-effectiveness of PhLi from a societal perspective in the Netherlands. The aim is to inform decision-makers about PhLi implementation before initiating a pilot study.
METHODS: Intervention-related costs were collected from literature and guidelines. An open-source discrete event simulation model was adapted using a lifetime time horizon and a societal perspective. A threshold analysis was conducted to obtain the maximum CHF-hospitalisation hazard ratio (HR) required for PhLi to be cost-effective compared to usual care. Additional analyses were performed for HR = 0.975. Model outcomes included costs, quality-adjusted life years (QALYs), life-years (LYs), hospitalisation count, and the incremental cost-effectiveness ratio (ICER). Sensitivity and scenario analyses were conducted to assess uncertainty.
RESULTS: At a willingness-to-pay threshold of €50,000, the HR threshold was 0.985. The ICER decreases to €37,827 for HR 0.975. At HR = 0.975 PhLi has increased costs (€92,730 vs €91,043), QALYs (2.538 vs 2.494), and LYs (4.541 vs 4.469), and fewer hospitalisations (3.953 vs 4.037). The probability of PhLi being cost-effective was 95.6%. This increased to 98.7% when workload was shared between the pharmacist and pharmacist assistant, and decreased to 84.4% when medication costs increased due to a 4% improvement in medication adherence. The HR had the largest effect on the ICER, followed by pharmacist costs, hospitalisation costs, and outpatient costs.
CONCLUSIONS: The findings indicate that PhLi could be cost-effective, even with a modest reduction in CHF-related hospitalisations. Although parameter uncertainty is considerable due to limited real-world evidence, analyses show that the intervention may remain cost-effective under less favourable assumptions. These findings are sufficiently promising to support initiating a pilot study.
METHODS: Intervention-related costs were collected from literature and guidelines. An open-source discrete event simulation model was adapted using a lifetime time horizon and a societal perspective. A threshold analysis was conducted to obtain the maximum CHF-hospitalisation hazard ratio (HR) required for PhLi to be cost-effective compared to usual care. Additional analyses were performed for HR = 0.975. Model outcomes included costs, quality-adjusted life years (QALYs), life-years (LYs), hospitalisation count, and the incremental cost-effectiveness ratio (ICER). Sensitivity and scenario analyses were conducted to assess uncertainty.
RESULTS: At a willingness-to-pay threshold of €50,000, the HR threshold was 0.985. The ICER decreases to €37,827 for HR 0.975. At HR = 0.975 PhLi has increased costs (€92,730 vs €91,043), QALYs (2.538 vs 2.494), and LYs (4.541 vs 4.469), and fewer hospitalisations (3.953 vs 4.037). The probability of PhLi being cost-effective was 95.6%. This increased to 98.7% when workload was shared between the pharmacist and pharmacist assistant, and decreased to 84.4% when medication costs increased due to a 4% improvement in medication adherence. The HR had the largest effect on the ICER, followed by pharmacist costs, hospitalisation costs, and outpatient costs.
CONCLUSIONS: The findings indicate that PhLi could be cost-effective, even with a modest reduction in CHF-related hospitalisations. Although parameter uncertainty is considerable due to limited real-world evidence, analyses show that the intervention may remain cost-effective under less favourable assumptions. These findings are sufficiently promising to support initiating a pilot study.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE618
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Thresholds & Opportunity Cost
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)