Cost-effectiveness of pharmacist-led care versus usual care in type 2 diabetic Jordanians: a Markov modeling of cardiovascular diseases prevention

ABSTRACT

Background

Cardiovascular diseases (CVDs) are responsible for one third of global deaths and the main cause of death among Jordanians. Pharmacist-led care was outlined previously as a cost-effective approach in the management of chronic illness; however, this is not well studied in low to middle-income countries.

Aim and objectives

To assess the cost-effectiveness of pharmacist-led care versus usual care in preventing CVDs in Type 2 Diabetes Mellitus (T2DM).

Method

A Markov model of one-year cycle length and 10-year time horizon was constructed to simulate 10-year CVD events, mortality, and costs for two hypothetical cohorts; usual care and pharmacist-led care, respectively, of Jordanian patients suffering from T2DM. Public health provider perspective was adopted. Outcomes examined were incremental costs, LYGs, and incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis (PSA) assessed the robustness of the results.

Result

The pharmacist-led care generated an additional 0.3 LYG/patient at an additional cost of JD1,238.78 (US$1,747.24) comparing to the usual care in the 10-year base-case analysis. Deterministic and PSA supported the robustness of base-case findings, indicating that pharmacist-led care is cost-effective.

Conclusion

The findings outline long-term clinical and economic benefits of expanding clinical pharmacist’s roles in direct patient care services.

KEYWORDS:

• Cost-effectiveness
• diabetes
• cardiovascular disease
• pharmacist
• Jordan
• middle east
• disease management
• prevention
• collateral damage
• patient stratification
• predictive preventive personalized medicine

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Data availability

All input data for the Markov model are available within the article and the electronic supplementary material. The decision model simulation is available from the corresponding author on reasonable request

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contribution

RM model design, data analysis, result interpretation, and manuscript writing. EH: study idea, result interpretation, and manuscript writing.

Appendix B Tornado diagram of key variables influencing the net monetary benefit of pharmacist-led care group compared to usual careEffect on net monetary benefit at Willingness to pay of JD 9,023/LYG

CABG coronary artery bypass grafting, CHD coronary heart disease, CT computed tomography, ECG electrocardiography, LYG life years gained, MRI magnetic resonance imaging

Additional information

Funding

This paper was not funded.