OBJECTIVES:

This “proof-of-concept” study aimed to carry out costing, cost-effectiveness, and cost-utility analyses of a real-world collaborative care intervention in hypertension and hyperlipidemia management using information technology between pharmacies and primary care in Portugal versus usual (fragmented) care alongside a trial.

METHODS:

An economic evaluation was conducted alongside a 6-month trial. The target population was adult patients on hypertension and/or lipid-lowering medication. We used a societal perspective. We collected patient-level resource use, costs, and outcomes using different real-world data sources at several time points. We used National Health Service (NHS) unit costs and micro-costing including Time-Driven Activity-Based Costing (TDABC) to estimate the cost of pharmacy and primary care interventions, and the human capital approach for paid and unpaid productivity loss costs. Effect outcomes included blood pressure (BP) and quality-adjusted life-years (QALYs). Bootstrapping was used to estimate uncertainty. Cost-effectiveness planes and acceptability curves were estimated.

RESULTS:

The intervention was not shown to have reasonable levels of cost-effectiveness or cost-utility when compared to usual care, as denoted by the levels of uncertainty expressed in wide confidence intervals. The probability for the intervention to be cost-effective is 28% at the threshold of €20,000 per QALY gained and 57% at the threshold of €500 per mmHg systolic BP decrease. The probability in the sensitivity analysis is similar to the base case.

CONCLUSIONS:

Considering the limitations of the trial which affected effectiveness and economic outcomes our findings are not generalizable for community pharmacy and primary care in Portugal. This research offers, however, valuable lessons on research methods and strategies that can be used to guide future TDABC costing and economic evaluations of pharmacy-based collaborative public health interventions with the potential for reimbursement.

Trial Registration: Current Controlled Trials (ISRCTN): ISRCTN13410498, retrospectively registered on 12 December 2018: https://www.isrctn.com/ISRCTN13410498