OBJECTIVES: The aim of this “proof-of-concept” study was to experiment cost-effectiveness and cost-utility analyses of a collaborative care intervention in hypertension and hyperlipidemia management between pharmacies and primary care in Portugal versus usual (fragmented) care alongside a trial.

METHODS: Data sources included: primary care clinical software; pharmacy dispensing software; patient telephone surveys; and published literature. Target population was adult patients on hypertension and/or lipid-lowering medication. This was a 6-month trial. The perspective was limited societal. The study intervention consisted of hypertension and/or hyperlipidemia management within a collaborative care framework between intervention pharmacies and primary care according to pre-defined integrated care pathways in the form of decision algorithms for hypertension and hyperlipidemia pre-agreed with primary care physicians and integrated in the pharmacy dispensing software. We collected patient-level data on resource use to estimate trial costs. We used self-reported BP and quality-of-life outcomes to derive QALYs. Incremental cost-effectiveness ratios and incremental cost-utility ratios were estimated.

RESULTS: The intervention was not shown to have reasonable levels of cost-effectiveness or cost-utility when compared to usual care, although there is a high level of uncertainty expressed in wide confidence intervals. The probability for the intervention to be cost-effective at the threshold €20,000 per quality-adjusted life-year is below 40% and below 20% at the threshold €500 per mmHg decrease. The average-case scenario in sensitivity analysis increases the probability to 55% (threshold €500 per mmHg decrease).

CONCLUSIONS: Taking into account the many limitations of this trial reported separately and the amount of evidence establishing effectiveness, cost-effectiveness and cost-utility for similar interventions, our findings are not generalizable for community pharmacy and primary care in Portugal. Further trials are required that can apply the technology-driven collaborative care using the lessons learnt from this experience.