Abstract
Background: Pharmacist interventions are one of the pivotal parts of a clinical pharmacy service within a hospital. This study estimates the cost avoidance generated by pharmacist interventions due to the prevention of adverse drug events (ADE). The types of interventions identified are also analysed. Methods: Interventions recorded by a team of hospital pharmacists over a one year time period were included in the study. Interventions were assigned a rating score, determined by the probability that an ADE would have occurred in the absence of an intervention. These scores were then used to calculate cost avoidance. Net cost benefit and cost benefit ratio were the primary outcomes. Categories of interventions were also analysed. Results: A total cost avoidance of €708,221 was generated. Input costs were calculated at €81,942. This resulted in a net cost benefit of €626,279 and a cost benefit ratio of 8.64: 1. The most common type of intervention was the identification of medication omissions, followed by dosage adjustments and requests to review therapies. Conclusion: This study provides further evidence that pharmacist interventions provide substantial cost avoidance to the healthcare payer. There is a serious issue of patient’s regular medication being omitted on transfer to an inpatient setting in Irish hospitals.
Highlights
Increased total per capita outpatient pharma expenditure by 10% was related to increase in life expectancy: a) at birth for men by 0.41% (p= 0.07), b) for men 65+ by 2.35% (p= 0.004), and c) at birth for women by 0.37% (p= 0.03)
A 10% increase of total pharma expenditure as a % of total current health expenditure as a % of GDP, was related to a reduction of total current health expenditure as a % of GDP by 3.3% (p= 0.045)
The cost containment measures implemented by the GPNP, have resulted in a reduction of the total pharmaceutical consumption by 11.5%
Summary
Clinical pharmacist interventions are actions which aim to improve a patient’s pharmaceutical care. This study has added to the body of evidence that clinical pharmacist interventions are cost effective over extended time periods and entire hospital settings. Results: Like most of Europe, the UK National Institute for Clinical Excellence (NICE) has been using a discount rate of 3.5% for both costs and health effects It has recently adopted a differential reference case where health effects are sustained over a period of 30 years or more: 1.5% for health effects and 3.5% for costs. Most European countries, with the exceptions of Belgium, The Netherlands and the UK in specific circumstances, continue to use the same discount rate for costs and health effects, thereby potentially undervaluing the long-term benefits current and new treatments. New technologies need to continue to be presented to payers in a manner which allows them to plan for fiscal pressure and service redesign
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