Pharmacist-Prescribing Intervention Leads to Cost-Effective Savings in Blood Pressure Care

Pharmacist-prescribing intervention intended to improve blood pressure could have an increased economic value when compared with the standard care, according to results of a study published in JAMA Network Open. The study authors reported a 50% uptick in pharmacist prescribing was associated with approximately $1.137 trillion in savings and approximately 30.2 million life years over a 30-year time period.¹

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Although pharmacist-led interventions have been shown to improve blood pressure control, data have not shown the larger scale effects in the United States, particularly on cost, according to study authors.^1,2 They aimed to determine whether pharmacist-led interventions could be cost effective in the United States.¹

Investigators of the study used a 5-state Markov model, based on the results of The Alberta Clinical Trial in Optimizing Hypertension (RxACTION) trial (NCT00878566), from 2009 to 2013.¹

In the RxACTION trial, investigators found that pharmacist prescribing for those with hypertension demonstrated a statistically significant reduction in blood pressure, with a mean reduction in systolic blood pressure of 18.3mm Hg at 6 months compared with 11.8 mm Hg in the control group with usual care from their pharmacist and physician. The mean baseline systolic and diastolic blood pressure for the sample was 150/84 mm Hg, according to the study investigators.²

The data of the current trial were analyzed from January to June 2023.¹

Using the data form the RxACTION trial, investigators measured cardiovascular events, end-stage kidney disease events, life years and quality-adjusted life years, lifetime costs, and lifetime incremental cost-effectiveness ratio. Furthermore, the study authors used the reimbursement rate for level 1 encounters, medication costs from literature, and event costs from national surveys and pricing data sets to determine the cost-effectiveness for pharmacist-led intervention.¹

The investigators also used a one-way sensitivity analysis to determine the alternative reimbursement values, reduced time horizons of 5 years, alternative assumptions for reductions in blood pressure, and the assumption of no benefit of the intervention after 10 years as part of the data measures, according to the study. The study authors expanded the model to the United States population beyond the RxACTION trial to estimate population-level cost and health impacts.¹

Investigators used demographics with the assumed mean age of 64 years, 49% male, and baseline blood pressure of 150/84 mm Hg. Over the 30-year period, there were 2100 fewer cases of cardiovascular disease and 8 fewer cases of kidney disease per 10,000 individuals when the pharmacist-led intervention was applied. Furthermore, the investigators reported 0.24 additional life years and 0.62 additionally quality-adjusted life years.¹

The study authors stated that $10,162 per person was saved as a result of fewer events with the intervention, even when adjusted for visit and medication costs. The cost-effectiveness ratio ranged from $2093 to $24,076 with the interventions, according to the results.¹

The study had limitations, according to the study authors, including that the cost savings analysis is only accurate for a 50% update in the intervention, so the savings would depend on the magnitude of the uptake.¹

References

1. Dixon DL, Johnston K, Patterson J, Marra CA, Tsuyuki RT. Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States. JAMA Netw Open. 2023;6(11):e2341408. doi:10.1001/jamanetworkopen.2023.41408
2. Tsuyuki RT, Houle SK, Charrois TL, Kolber MR, et al. Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community: The Alberta Clinical Trial in Optimizing Hypertension (RxACTION). Circulation. 2015;132(2):93-100. doi:10.1161/CIRCULATIONAHA.115.015464