About one in ten Americans has type 2 diabetes mellitus (T2DM). Poorly managed diabetes causes serious complications that diminish quality of life and life expectancy, with substantial cost to the healthcare system and patients. Pharmacists are well-equipped to provide medication therapy management (MTM) services for managing diabetes, but cost-effectiveness of MTM is not known.

OBJECTIVES: To evaluate the cost-effectiveness of MTMC, versus no MTMC, for treating patients with T2DM.

METHODS: Clinical data for 78 individuals with T2DM treated at University of Illinois Hospital & Health Sciences System’s MTMC during 2001-2012 were collected from electronic medical records. A control group with the same characteristics was simulated. Adjusted difference-in-difference estimates of -0.63 for HbA1c and -8.21 for systolic blood pressure, both favoring MTMC (versus no MTMC), were obtained from a previously published study on one-year impact of MTMC in the same patient sample. UKPDS Outcomes Model was used to obtain annual T2DM complication rates over ten years for both groups. Costs and utilities for T2DM complications, obtained from published literature, were applied to those with each complication in each year. Primary outcomes, discounted at 3% annually, included total costs (TC) and quality-adjusted life years (QALYs). Sensitivity analyses were conducted to evaluate uncertainty.

RESULTS: All results reported are over ten years. Without considering MTM service costs, MTMC group incurred $203,583 TC and 4.7524 QALYs. No MTMC group incurred $204,807 TC and 4.7419 QALYs. At current reimbursement rates, to be cost-effective at willingness-to-pay thresholds of $50,000 and $150,000 per QALY gained, patients can be provided 27 and 45 MTMC visits, respectively, to reach and maintain the observed HbA1c and SBP. For every 1000 patients treated, MTMC avoided 2.10 myocardial infarctions, 6.11 strokes and 2.11 amputations.

CONCLUSIONS: Current reimbursement models may need to be revised to incentivize provision of MTM services to T2DM patients.