PDF
Published
2024-09-18
Issue
Section
Pharmacy Practice & Practice-Based Research
Categories
License
Copyright (c) 2024 Cynthia King, Benjamin King, Tara Nagaraj, David Gothard
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of content published in INNOVATIONS in pharmacy belongs to the author(s).
Cost-Effectiveness Analysis of Pharmacist-Led Diabetes Management Across Primary Care Clinics
Cynthia King
MetroHealth System
https://orcid.org/0000-0002-9678-7623
Benjamin King
MetroHealth System
Tara Nagaraj
MetroHealth System
David Gothard
Biostats, Inc. of Ohio
DOI: https://doi.org/10.24926/iip.v15i3.6300
Keywords: ambulatory care, pharmacist, diabetes mellitus, cost-effectiveness
Abstract
Purpose: Ambulatory care pharmacists (ACPs) on healthcare teams improve patient outcomes and help manage multiple chronic disease states.1 ACPs have demonstrated clinical benefit but need to show sustainability. The primary objective of this study is to determine the cost effectiveness of utilizing ACPs for diabetes mellitus (DM) management.
Methods: This was a retrospective, multi-site cohort study of 406 diabetic patients, > 18 years of age, with a HbA1c of > 8%, receiving primary care services within an academic health system between May 2015 to March 2018. In the ACP group, the ACP + primary care provider (PCP) + endocrinology managed patients’ DM compared to the PCP group, where DM was managed by PCP + endocrinology. To assess cost effectiveness of an ACP, costs of services were evaluated along with changes in HbA1c per patient per year.
Results: The ACP cost was $126 for each additional HbA1c percent lowered. The cost associated with moving one additional patient with HbA1c > 9% to HbA1c < 9% was $612. Based on facility fee billing, the ACPs cover approximately 70% of their annual salary and benefits from face-to-face visits. Change in HbA1c over 12 months was -2.5% in the ACP group and in the PCP group +1.08% (p<0.001). Based on quality metrics at 12-months, the ACP group met the goal of 75% of patients having a HbA1c < 9% and being prescribed a statin vs. the PCP group only met the metric for statin use.
Conclusions: ACPs led to significantly improved clinical outcomes with marginal up-front costs that could lead potential future cost savings through reductions in DM related complications or improving incentivized returns by achieving goal quality metric levels.
