Costs of a community pharmacist-led medicines management service for patients with coronary heart disease in England: healthcare system and patient perspectives

Background: Coronary heart disease (CHD) is the most common cause of death in the UK. CHD cost the UK National Health Service (NHS) £3.5 billion in 2003. The economic impact of community pharmacists providing a medicines management service for patients with CHD has not been rigorously evaluated; the full economic costs of such interventions are rarely presented in the literature. Objective: To examine the incremental costs of a 1-year community pharmacistled medicines management service for patients with CHD in the UK, from a healthcare system and patient perspective. Methods and participants: A cost-minimisation analysis was conducted alongside a multicentre randomised controlled trial. The primary study participants were patients with CHD identified from general practice computer records. Patients (intervention, n = 980; control, n = 500) from 38 general practices in nine geographical areas in the UK were included in the study. Intervention and outcomes measures: The intervention consisted of a review of pharmaceuticals and lifestyle advice by pharmacists in their premises, with recommendations communicated to the patient's GP. The main outcome measure was the incremental cost per patient in the intervention group compared with the control group. Annual costs (£, 2003/4 values) included the costs of the intervention (training and delivery costs), the usual costs of NHS treatment (costs of pharmaceuticals, GP and hospital visits) and costs borne by patients. Data were collected in the 12 months before and 12 months after the intervention. Results: The total NHS cost increased between baseline and follow-up in both groups (from £1243 to £1286 [3%] in the control group and from £1410 to £1433 [2%] in the intervention group). The greater cost in the intervention group largely reflects the additional cost of the pharmacist training and the time taken to deliver the intervention; the difference in costs between the intervention and control groups, after controlling for differences in costs at baseline at follow-up, was statistically significant (p = 0.001). The costs of pharmaceuticals was higher in the intervention group (£769.20 vs £742.3; p = 0.04). According to the sensitivity analysis, the intervention cost would need to decrease by 35% to achieve equivalence between costs in each arm of the trial. Difference to costs of patients and their carers at follow-up were not statistically significant. Conclusions: The introduction of a 1-year pharmacist-led medicines management service is likely to increase the total cost of CHD treatment and prevention from the healthcare perspective, as the cost of the intervention outweighed the observed reduction in the cost of drugs in the intervention group. No changes in costs from the patient perspective were found.