Cost-effectiveness of pharmacist intervention in oral antidiabetic-treated and insulin-treated type 2 diabetes mellitus patients
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Keywords
type 2 diabetes mellitus, antidiabetics, pharmacist intervention, cost-effectiveness analysis
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a significant global health issue and projected to affect around 643 million people by 2030. Objectives: This study analyzed the cost-effectiveness of pharmacist intervention in oral antidiabetic-treated and insulin-treated T2DM outpatients admitted to the University of Sumatera Utara (USU) Hospital, Medan, Indonesia. Methods: This pre and post quasi-experimental economic study analyzed the costeffectiveness of pharmacist intervention in oral antidiabetic-treated and insulin-treated T2DM outpatients (n=106) admitted to USU Hospital based on payer perspective, period from April to July 2023. Baseline data for one-month treatment were assessed before pharmacist intervention. The pharmacist intervention was provided monthly for the following 3 months. The materials provided in the pharmacist intervention consisted of T2DM educational brochures and patient counseling. The clinical outcome measured pre and post pharmacist intervention was the proportion (%) of the patients with controlled glycated haemoglobin (HbA1c). Monthly direct medical costs before and after intervention were extracted from these patients’ medical records. Cost-effectiveness ratios (CER) and incremental cost-effectiveness ratios (ICERs) for the oral antidiabetic and insulin therapies provided to these patients were analyzed. In this study, one-way sensitivity analysis and WHO threshold were also performed. Appropriate statistical analyses were also applied in this study. Results: Most (54.71%) of the T2DM patients were female. Their mean age was 58.61 ± 8.89 years. Of the 106 patients, 48 and 58 patients received oral antidiabetics and insulin therapies, respectively. CER (USD) for oral antidiabetic-treated patients: before pharmacist intervention, 39.67; after pharmacist intervention, 30.76. CER (USD) for insulin-treated patients: before pharmacist intervention, 1,326.78; after pharmacist intervention, 206.99. ICERs (USD) for: oral antidiabetic-treated patients, 2.7471; insulin-treated patients, -86.1376. Conclusion: Management of oral antidiabetic-treated and insulin-treated T2DM patients with pharmacist intervention was more cost-effective compared to that of standard treatment
References
2. Pusdatin. Pusat Data dan Informasi Kementrian Kesehatan RI. 2020. https://pusdatin.kemkes.go.id/article/view/20111800001/diabetes-melitus.html.
3. da Rocha Fernandes J, Ogurtsova K, Linnenkamp U, Guariguata L, Seuring T, Zhang P, et al. IDF Diabetes Atlas estimates
of 2014 global health expenditures on diabetes. Diabetes Res Clin Pract. 2016; 117:48-54. https://doi.org/10.1016/j.diabres.2016.04.016
4. Arifin B, Idrus LR, van Asselt ADI, Purba FD, Perwitasari DA, Thobari JA, et al. Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D. Qual Life Res. 2019;28(5):1179-90. https://doi.org/10.1007/s11136-019-02105-z
5. Aguiar PM, da Silva CH, Chiann C, Dórea EL, Lyra Jr DP, Storpirtis S. Pharmacist–physician collaborative care model for patients with uncontrolled type 2 diabetes in Brazil: results from a randomized controlled trial. J Eval Clin Pract. 2018;24(1):22-30. https://doi.org/10.1111/jep.12606.
6. Bukhsh A, Nawaz MS, Ahmed HS, Khan TM. A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among type 2 diabetes patients: A consort compliant study protocol. Medicine. 2018;97(12):e9847. https://doi.org/10.1097%2FMD.0000000000009847
7. Syarifuddin S, Nasution A, Dalimunthe A. Impact of pharmacist intervention on improving the quality of life of patients with type 2 diabetes mellitus. Open Access Maced J Med Sci. 2019;7(8):1401. https://doi.org/10.3889/oamjms.2019.140
8. Pöhlmann J, Russel-Szymczyk M, Holík P, Rychna K, Hunt B. Treating patients with type 2 diabetes mellitus uncontrolled on basal insulin in the Czech Republic: cost-effectiveness of IDegLira versus iGlarLixi. Diabetes Ther. 2019;10(2):493-508. https://doi.org/10.1007/s13300-019-0569-7
9. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open-Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com, updated 2013/04/06, accessed 2024/01/20. https://www.openepi.com/SampleSize/SSCohort.htm.
10. Imran SA, Agarwal G, Bajaj HS, Ross S, Diabetes Canada Clinical Practice Guidelines Expert Committee. Targets for glycemic control. Can J Diabetes. 2018;42:S42-6. https://doi.org/10.1016/j.jcjd.2017.10.030
11. Basskin LE. Practical Pharmacoeconomics: How to design, perform and analyze outcomes research. American Society of
Health-System Pharmacists; 1998.
12. Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nat Rev Endocrinol. 2021;17(9):534-48. https://doi.org/10.1038/s41574-021-00512-2
13. Raphael M, Vijayanarayana K, Thunga G, Rao NK, Sreedharan N. Utilization Pattern of Anti-Diabetic Drugs in Type 2 Diabetes Mellitus in Tertiary Care Hospital. RJPT. 2017;10(7):2063-8. http://dx.doi.org/10.5958/0974-360X.2017.00360.2.
14. Sridhar I, Padma P, Ahmed Z, Siddiqua SA. Study on oral anti-diabetic drug utilization pattern in diabetes mellitus type 2 patients at a tertiary care hospital. NJPPP. 2021;11(10):1159-63. https://doi.org/10.5455/njppp.2021.11.05158202128052021.
15. Walley T, Haycox A, Boland A. Pharmacoeconomics. Edinburgh: Churchill Livingstone, 2004.
16. The World Bank. Internet; 2023. Accessed December 28, 2023. https://data.worldbank.org/indicator/NY.GDP.PCAP. CD?locations=ID.
17. Shiroiwa T, Sung YK, Fukuda T, Lang HC, Bae SC, Tsutani K. International survey on willingness‐to‐pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness? Health Econ. 2010;19(4):422-37. https://doi.org/10.1002/hec.1481.
18. Li J, Sun L, Hou Y, Chen L. Cost-effectiveness analysis of a mobile-based intervention for patients with type 2 diabetes mellitus. Int J Endocrinol. 2021:2021:8827629. https://doi.org/10.1155/2021/8827629
19. Desse TA, Vakil K, Mc Namara K, Manias E. Impact of clinical pharmacist interventions on health and economic outcomes in type 2 diabetes: A systematic review and meta‐analysis. Diabet Med. 2021;38(6):e14526. https://doi.org/10.1111/dme.14526
20. Rosli MR, Wu DB, Neoh CF, Karuppannan M. Economic evaluation of home medication review by community pharmacists
(HMR-CP) for patients with type 2 diabetes mellitus (T2DM). J Med Econ. 2021;24(1):730-40. https://doi.org/10.1080/13696998.2021.1889573
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