OBJECTIVES:

1) To explore variation in patient preferences and estimate willingness-to-accept (WTA) annual cost to the National Health Service (NHS) for attributes of a collaborative intervention between pharmacies and primary care in Portugal using a Discrete Choice Experiment (DCE); 2) to incorporate DCE into an economic evaluation using cost-benefit analysis (CBA).

METHODS:

A convenience sample of hypertension and hyperlipidemia intervention and control patients was selected to complete the DCE at the end of a collaborative trial between pharmacies and primary care in Portugal. We used five attributes: waiting time to get medical appointment, model of pharmacy intervention, integration with primary care, chance of having a stroke in 5 years, and annual cost to the NHS. We used an experimental orthogonal fractional factorial design. Data were analyzed using conditional logit.

RESULTS:

Waiting time to get medical appointment on the same day (urgent) and within 15 days (non-urgent) was the most important attribute, followed by 30-minute pharmacy intervention in private office every 6 months for point-of-care measurements and medication review of all medicines, and full integration with primary care. The cost attribute was not significant. Intervention patients were willing to accept the NHS annual cost of €877 for their preferred scenario. The annual net benefit per patient is €788.20 and represents the monetary value of patients’ welfare surplus for this model.

CONCLUSIONS:

This study is the first conducted in Portugal alongside a pharmacy collaborative trial, incorporating DCE into CBA. The findings can be used to guide the design of pharmacy collaborative interventions with primary care with the potential for reimbursement for uncontrolled or at-risk chronic disease patients informed by patient preferences. Future DCE studies conducted in community pharmacy may provide additional contributions to this research.

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