A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy

Abstract Background Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community phar...

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Autores principales:	Noelia Amador-Fernández, Shalom I. Benrimoj, Leticia García-Mochón, Victoria García-Cárdenas, Sarah Dineen-Griffin, Miguel Ángel Gastelurrutia, Jesús Carlos Gómez-Martínez, Vicente Colomer-Molina, Fernando Martínez-Martínez
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Community pharmacy services Primary health care Self care Self medication Nonprescription drugs Cost-utility analysis; minor ailment service Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/aaf80ace2ad24663a87f8f2c7450dc85
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spelling	oai:doaj.org-article:aaf80ace2ad24663a87f8f2c7450dc852021-11-21T12:06:16ZA cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy10.1186/s12913-021-07188-41472-6963https://doaj.org/article/aaf80ace2ad24663a87f8f2c7450dc852021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07188-4https://doaj.org/toc/1472-6963Abstract Background Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). Methods The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists’ training, practice change facilitators and patients’ educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals’ consultation time, medication costs, pharmacists’ training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. Results A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. Conclusions Expanding community pharmacists’ scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. Trial registration ISRCTN, ISRCTN17235323 . Registered 07/05/2021 - Retrospectively registeredNoelia Amador-FernándezShalom I. BenrimojLeticia García-MochónVictoria García-CárdenasSarah Dineen-GriffinMiguel Ángel GastelurrutiaJesús Carlos Gómez-MartínezVicente Colomer-MolinaFernando Martínez-MartínezBMCarticleCommunity pharmacy servicesPrimary health careSelf careSelf medicationNonprescription drugsCost-utility analysis; minor ailment servicePublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Community pharmacy services Primary health care Self care Self medication Nonprescription drugs Cost-utility analysis; minor ailment service Public aspects of medicine RA1-1270
spellingShingle	Community pharmacy services Primary health care Self care Self medication Nonprescription drugs Cost-utility analysis; minor ailment service Public aspects of medicine RA1-1270 Noelia Amador-Fernández Shalom I. Benrimoj Leticia García-Mochón Victoria García-Cárdenas Sarah Dineen-Griffin Miguel Ángel Gastelurrutia Jesús Carlos Gómez-Martínez Vicente Colomer-Molina Fernando Martínez-Martínez A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
description	Abstract Background Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). Methods The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists’ training, practice change facilitators and patients’ educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals’ consultation time, medication costs, pharmacists’ training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. Results A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. Conclusions Expanding community pharmacists’ scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. Trial registration ISRCTN, ISRCTN17235323 . Registered 07/05/2021 - Retrospectively registered
format	article
author	Noelia Amador-Fernández Shalom I. Benrimoj Leticia García-Mochón Victoria García-Cárdenas Sarah Dineen-Griffin Miguel Ángel Gastelurrutia Jesús Carlos Gómez-Martínez Vicente Colomer-Molina Fernando Martínez-Martínez
author_facet	Noelia Amador-Fernández Shalom I. Benrimoj Leticia García-Mochón Victoria García-Cárdenas Sarah Dineen-Griffin Miguel Ángel Gastelurrutia Jesús Carlos Gómez-Martínez Vicente Colomer-Molina Fernando Martínez-Martínez
author_sort	Noelia Amador-Fernández
title	A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
title_short	A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
title_full	A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
title_fullStr	A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
title_full_unstemmed	A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
title_sort	cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
publisher	BMC
publishDate	2021
url	https://doaj.org/article/aaf80ace2ad24663a87f8f2c7450dc85
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A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy

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