PDB26 - Cost-Effectiveness of Community Pharmacists’ Support of Lifestyle Habit Improvements Prevention of Diabetic Nephropathy in Type 2 Diabetes

Abstract

The purpose of this study is to evaluate the cost effectiveness of support by community pharmacists in Japan of lifestyle habit improvements for prevention diabetic nephropathy. We conducted the Community Pharmacists Assists (COMPASS) Project, a randomized controlled trial with a cluster of 50 community pharmacies in Japan. In the project, community pharmacists spent 3 minutes with patients with type 2 diabetes mellitus (T2DM) over a period of 6 months to support lifestyle habit improvements. As a result, changes in HbA1c levels in the intervention group (IG) were significantly greater than changes in the control group (CG) (IG:-0.7% vs CG:-0.3%). Using the Markov model, we evaluated the cost-effectiveness of pharmacist intervention in the COMPASS Project for future diabetic nephropathy. The analysis was conducted from the viewpoint of the payer, with the period for the analysis set to 20 years. The progression of diabetic nephropathy was divided into 4 stages, and the cost (JPY) and the quality-adjusted life years (QALY) were estimated by simulating the transition of the state stage. The average cost effectiveness ratio (CER) was calculated- using a 3% discount rate. Medical cost in the survey period was calculated at 2,353,121 JPY for the intervention group, while it was 2,939,521 JPY for the control group. In addition, QALY was 13.01 for the intervention group and 12.77 for the control group. Using this information, CER was 180,870.177 JPY/QALY for the intervention group and 230,189.585 JPY/QALY for the control group. Therefore, medical costs in this study were more effective for the intervention group than for the control group. This analysis indicates that intervention by a pharmacist is cost effective for patients with type 2 diabetes, suggesting that pharmacists should more actively participate in diabetes care as lifestyle coaches.