COST-EFFECTIVENESS OF INCREASING STATIN ADHERENCE FOR PRIMARY AND SECONDARY PREVENTION IN COMMUNITY PHARMACIES

Author(s)

Vegter S*1;Oosterhof P1;van Boven JF1;Stuurman-Bieze AGG2;Hiddink EG2, Postma MJ1 1University of Groningen, Groningen, Netherlands, 2Health Base Foundation, Houten, Netherlands

OBJECTIVES: Therapy persistence is important to achieve optimal clinical benefits of statin therapy. The aim of this study was to determine the cost-effectiveness of pharmaceutical care in community pharmacies, aimed to increase persistence with statin therapy for both primary and secondary prevention of cardiovascular events (CVEs). METHODS: The effectiveness of the Dutch pharmaceutical care program MeMO on improving statin therapy persistence was measured in 500 patients and compared to 502 control patients. Time-investments of the program were also collected. Markov models with lifelong time-horizons were developed to estimate the influence of the program on CVEs: stroke, myocardial infarction (MI), revascularization and mortality. The efficacy of statins, taken from large clinical trials in primary and secondary prevention, were adjusted for therapy persistence. A Dutch healthcare provider’s perspective was adopted for the analysis and probabilistic sensitivity analyses were performed. RESULTS: Patients in the MeMO program had a lower risk for non-persistence, RR = 0.50 (0.40-0.63), the effect was similar in primary and secondary prevention. In a cohort of 1,000 patients, 60% of whom had a history of CVE, the MeMO program resulted in a reduction of 8 non-fatal strokes, 2 fatal strokes, 16 non-fatal MIs, 7 fatal MIs and 14 revascularizations. Additional medication, disease management and intervention costs in the MeMO program were €375,000; the cost-savings due to reduced CVEs were €450,000. Thus, the MeMO program resulted in 83 quality-adjusted life-years (QALYs) gained and cost-savings of €75,000. Clinical benefits and cost-savings were highest in the secondary prevention population. CONCLUSIONS: Pharmaceutical care in community pharmacies can improve statin therapy persistence, resulting in more optimal prevention of CVEs. The MeMO program resulted in considerable clinical benefits and overall cost-savings. Persistence and adherence improving programs in community pharmacies may provide good value for money and healthcare insurers should consider reimbursing these activities in the Netherlands.

Conference/Value in Health Info

2013-11, ISPOR Europe 2013, The Convention Centre Dublin

Value in Health, Vol. 16, No. 7 (November 2013)

Code

PCV96

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Cardiovascular Disorders

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