PMU12 AN OVERVIEW OF SYSTEMATIC REVIEWS OF ECONOMIC EVALUATIONS OF PHARMACY-BASED PUBLIC HEALTH INTERVENTIONS: ADDRESSING METHODOLOGICAL CHALLENGES

Abstract

To perform an overview of systematic reviews of economic evaluations of pharmacy services and triangulate results with recommendations for economic evaluations of public health interventions and recommendations for economic evaluations alongside trials. 1) Exploratory review of recommendations on the economic evaluation of public health interventions; 2) Exploratory review of recommendations for conducting economic evaluations alongside trials; 3) Overview of systematic reviews of economic evaluations of pharmacy interventions in 8 databases. Methods are detailed in protocol registered with PROSPERO (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016032768). A threefold critical appraisal of the methodology was performed: 1) Quality of included reviews; 2) Quality of evidence of community pharmacy primary studies reported in reviews; 3) Applicability and transferability. Fourteen systematic reviews containing 75 index publications were included. Reviews reported favorable economic findings for 71% of studies with full economic evaluations. The types of economic analysis are diverse. Two critical quality domains are absent from most reviews. Key findings include: certain types of risk of bias more frequent; wider scope of study designs; most economic quality criteria are met but some issues unresolved or unclear; heterogeneity in populations, interventions and some outcomes; equity not assessed; process dimensions poorly described. Triangulation reveals additional gaps. The economic evaluation of pharmacy interventions presents challenges. Since in recent years, payers made substantial changes in pharmacy remuneration systems, including contracting with Pharmacies and paying for relevant interventions, we hope these findings may assist in improving the design, implementation and assessment of pilot trials, hence the robustness of evidence to justify payers’ investment. We also propose a methodological approach for future research in performing economic evaluations of pharmacy-based public health interventions. As research expands, it will become important to build a multidisciplinary expert consensus around a specific guidance on economic evaluation of pharmacy-based public health interventions.