Abstract
ABSTRACTOBJECTIVE:To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital.METHODS:This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB).RESULTS:The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI −31,850 − –10,610), -US$27,112 (95%CI −33,160–11,720) for the hospital and; 3.0 (95%CI 1.97–4.94), US$51,048 (95%CI 27,645–75,716) and, 4.6 (95%CI 2.24–10.05), US$91,496 (95%CI 34,700–168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively.CONCLUSIONS:The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.
Highlights
The most prevalent neurological diseases, especially if considered in more advanced stages, generally require pharmacological treatments, whose use is characterized by complex dosage, potential for interaction with other medication and/or the occurrence of important adverse reactions[1,2].Negative events associated with medication treatment are the cause of 5 to 10 % of hospital admissions, and between 50 and 60% of these could be prevented
The benefit-cost ratio (BCR) and net benefit (NB) were 0.0, -US$26,105 (95%CI -31,850 – -10,610), -US$27,112 (95%CI -33,160–11,720) for the hospital and; 3.0 (95%CI 1.97–4.94), US$51,048 (95%CI 27,645–75,716) and, 4.6 (95%CI 2.24–10.05), US$91,496 (95%CI 34,700–168,050; p < 0.001) for the Public Health System (PHS), both considering adhered and total interventions, respectively
The clinical pharmacy (CP) service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS
Summary
Negative events associated with medication treatment are the cause of 5 to 10 % of hospital admissions, and between 50 and 60% of these could be prevented. The responsibilities of the clinical pharmacist in the hospital environment should occur from the moment of patient admission to patient discharge. This activity refers to the review of current medical prescriptions and evaluation of possible inconsistencies in relation to the patient’s medical history, based on prior medical prescriptions. Pharmacotherapeutic interventions can occur at these three moments: hospital admission, during hospitalization, and discharge[3,4,5,6,7]
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