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

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: Dec 1, 2017
• 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: https://nottingham-repository.worktribe.com/output/876460
• Publisher URL: https://link.springer.com/article/10.1007/s40273-017-0554-9
• Additional Information: The final publication is available at Springer via http://dx.doi.org/10.1007/s40273-017-0554-9