Table 3 Characteristics of included economic studies

Campins (2019, Campins study)

Third party payer, public, Spain

CBA

12 months post-intervention

Usual GP care

Pharmacist performed chart review. Pharmacist discussed recommendations with GP and therapeutic plan made. Recommendations were discussed with the patient, and a final decision was agreed by physicians and their patients in a face-to-face visit

Drug expenditure savings per patient/year attributable to intervention: €88.42

Drug costs reduction: Intervention: €321.43 (CI = 233.77–409.79) Control: €232.94 (CI = 141.64–323.15) Intervention cost: €37.17

The estimated return per Euro invested in the programme: €3.27 per patient a year on average

Cowper (1998, Hanlon study)

Third party payer, public, US

CEA

12 months

Usual care with closeout interview by second pharmacist blinded to allocation

Comprehensive medication review with the pharmacist in practice and follow-up at 11.5–13 months

Cost-effectiveness as reported by MAI score:

€1122.64/one unit change (estimated by researchers)

Jodar-Sanchez (2015, Varas-Doval study)

Third party payer, public, Spain

CUA

12 months

Usual care

Community pharmacists provided Medication review with follow up (MRF). Pharmacist communicated with GPs via face to face or telephone. Follow up on a monthly basis for duration of the intervention

Incremental effectiveness (intervention vs control)

0.0156 QALYs (SD = 0.004) (95% CI 0.008– 0.023)

Mean incremental total cost of intervention

-€321.88 ± 190.95 (95% CI -696.14 to 52.37)

Noain (2017, Varas-Doval study)

Third party payer, public, Spain

Micro-costing, cost analysis

12 months

Usual care

Community pharmacists provided medication review to patients with follow-up with GPs and patients. Same study as Jodar-Sanchez above

Service provider cost per patient ranged from €251.72 (SD 90.5) to €398.12 (SD 164.4)

The mean initial investment per pharmacy was €5899.92 and the mean annual maintenance costs €3940.13

The potential service price ranged from €304.37 to €806.52 per patient a year

Malone (2000, Carter study)

Third party payer, public, US

Cost analysis

Not reported, costs calculated for 12 months prior to trial and 12 months of trial

Usual GP care

Patients were assessed by pharmacists at least three times (baseline, 6 & 12 months) but could see the patients as often as was medically indicated. Documentation via a standardised form was used for all patient encounters. Pharmacists saw patients in clinic or spoke on the phone. Discussed recommendations with GP

Mean increases in total health care costs were €1553.89 for the intervention group and €2000.25 for the control group (p = 0.06)

Effectiveness studies with cost and cost-effectiveness data

Bernsten (2001)

Third party payer, pan-European study, reported from Sweden

Cost analysis

18-month trial period

Usual care

Pharmacists completed study training and informed local GPs and formed formal links. Patient received pharmaceutical care intervention in collaboration with GPs

Total cost:

Between-group analysis indicated that there were no significant differences between the total cost for control and intervention patients in any country (Mann–Whitney, p > 0.05)

Hospitalisations

Germany, intervention patients had significantly lower costs associated with hospitalisations and contacts with specialists compared with control patients in the second 6-month period (Mann–Whitney test, p < 0.05)

Cost savings

Cost savings were achieved in most of the countries at each assessment period

Britton (1991)

Third party payer, US

Cost analysis

3-month trial period

Usual care

Pharmacist reviewed patient treatment and cost. Medication profile review form attached to each patient file for review by GP. Post GP consult, the pharmacist reviewed files for no. meds, meds changes and compliance

Intervention total cost savings: €287.93

Control total cost savings: costs increased by €1295.93

Intervention total cost avoidance: €1588.39

Jameson (2001)

Third party payer, US

Cost analysis

9-month trial period

Usual care

Medication review with patient in practice. Discussed DRPs with GP. Care plan developed with GP. Changes discussed with patient

No significant differences were demonstrated in the changes in medical or drug costs between the consult and the control groups

Drug Changes at follow-up

Intervention:

Change €73.87 (904.06)

Control:

Change €23.45 (11,257.98)

Medical changes at follow-up

Intervention:

Change €632.02 (11,716.46)

Control:

Change €367.02 (12,231.22)

Krska (2001)

Third party payer, UK

Cost analysis

3-month trial period

Usual care

Pharmacist performed chart review followed by medication review with patient in their own home. Pharmaceutical care plan developed in practice. Notes forwarded to GP who indicated level of agreement. Implemented actions where appropriate

No significant difference at baseline or follow-up

Intervention Medication Costs (mean, SD)

Baseline: €76.27 (56.52)

Follow-up: €75.49 (57.55)

Control Medication Costs

Baseline: €83.21 (65.13)

Follow-up: €82.84 (61.90)

Sellors (2003)

Third party payer, Canada

Cost analysis

5-month trial period

Usual care

Community pharmacists (who had additional post-university training in the prevention, identification, and resolution of drug-related problems) conducted face-to-face medication reviews with the patients and then gave written recommendations to the physicians to resolve any drug-related problems

Mean daily cost of medications per patient (intervention vs control)

€4.10 vs €3.94 (p = 0.72)

Mean total cost of medications per patient (intervention vs control)

€2.92 vs €3.08 (p = 0.78)

Mean cost of healthcare resources per patient (intervention vs control)

€1047.97 vs €1062.78 (p = 0.45)

Sloeserwij (2019)

Third party payer, Netherlands

Cost analysis

12-month trial period

Usual care was normal GP review. Usual care plus was medication review conducted by accredited community pharmacist

Pharmacists embedded in general practices for three months prior to intervention. Pharmaceutical care for high-risk patients- pharmacist performed medication reviews with patients and medications reconciliation amongst other practice-related activities

Intervention vs usual care only. No difference in healthcare or medication costs reported

Ratio of healthcare costs in intervention group vs usual care group (95% CI)

Primary care costs: 1.08 (0.99–1.17) p = 0.073

Secondary care costs: 0.92 (0.65–1.29) p = 0.622

Medication costs: 1.04 (0.98–1.10) p = 0.172

Secondary healthcare costs related to hospitalisations:

No differences: adjusted ratio 0.82 (95% CI 0.64–1.06)

Sorensen (2004)

Third party payer, Australia

CEA

6-month trial period

Usual care

GPs were the units of randomization. GPs made referrals to the community pharmacist who conducted medication review based on pharmacy data and medical records. Prepared report for GP, recommendations discussed at MDT meeting and action plan developed. GP implemented plan with patient agreement

The cost–effectiveness ratio for the intervention based on cost savings, reduced adverse events and improved health outcomes was small

Cumulative cost/patient over the 8 months from enrolment

Intervention: €5806.45

Control: €6160.15

Net cost saving per intervention patient (marginal cost benefit) was €58.05 per patient relative to controls

Incremental cost–effectiveness ratio in reducing ADEs and in improving DUSOI-A for the groups

ADEs: €74.18

DUSOI-A: €69.88