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Cost effectiveness of support for people starting a new medication for a long term condition through community pharmacies: an economic evaluation of the New Medicine Service (NMS) compared with normal practice

Elliott, Rachel A.; Tanajewski, Lukasz; Gkountouras, Georgios; Avery, Anthony J.; Barber, Nick; Mehta, Rajnikant; Boyd, Matthew J.; Latif, Asam; Chuter, Antony; Waring, Justin

Authors

Rachel A. Elliott

Lukasz Tanajewski

Georgios Gkountouras

Nick Barber

Rajnikant Mehta

Asam Latif

Antony Chuter

Justin Waring



Abstract

Background: The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost-effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs.

Methods: We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients’ non-adherence. Clinical event probability, treatment pathway, resource-use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted-life-year(QALY) were calculated from the perspective of NHS England, using a lifetime horizon.

Results: NMS generated a mean of 0.05 (95%CI: 0.00, 0.13) more QALYs per patient, at a mean reduced cost of -£144 (95%CI: -769, 73). The NMS dominates normal practice with probability of 0.78 (ICER: - £3166 per QALY). NMS has a 96.7% probability of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY.


Conclusions: Our study suggests that the New Medicine Service increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost.

Citation

Elliott, R. A., Tanajewski, L., Gkountouras, G., Avery, A. J., Barber, N., Mehta, R., …Waring, J. (2017). Cost effectiveness of support for people starting a new medication for a long term condition through community pharmacies: an economic evaluation of the New Medicine Service (NMS) compared with normal practice. PharmacoEconomics, 35(12), 1237-1255. https://doi.org/10.1007/s40273-017-0554-9

Journal Article Type Article
Acceptance Date Jul 17, 2017
Online Publication Date Aug 3, 2017
Publication Date 2017-12
Deposit Date Jul 20, 2017
Publicly Available Date Aug 3, 2017
Journal PharmacoEconomics
Print ISSN 1170-7690
Electronic ISSN 1179-2027
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 35
Issue 12
Pages 1237-1255
DOI https://doi.org/10.1007/s40273-017-0554-9
Keywords Long term condition, Medicines adherence, Community pharmacy, Randomised controlled trial, Economic evaluation, Markov modelling
Public URL http://eprints.nottingham.ac.uk/id/eprint/44314
Publisher URL https://link.springer.com/article/10.1007/s40273-017-0554-9
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0
Additional Information The final publication is available at Springer via http://dx.doi.org/10.1007/s40273-017-0554-9

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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