A new Virginia Commonwealth University School of Pharmacy–led study sought to estimate the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve BP control in the United States overall.
A report published in Journal of the American Medical Association Network Open discussed an economic evaluation that included a 5-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (or RxACTION; 2009–2013).
In the trial, control group patients received an active intervention, including a BP wallet card, education, and usual care, with data analyzed from January 2023 to June 2023.
The focus was on cardiovascular (CV) events, end-stage kidney disease events, life years, quality-adjusted life years (QALYs), lifetime costs, and lifetime incremental cost-effectiveness ratio (ICER). The researchers calculated CV risk using Framingham risk equations. The model was expanded to the U.S. population to estimate population-level cost and health impacts.
The model also assumed demographics, including mean (SD) age (64 [12.5] years), 121 (49%) male, and a mean (SD) baseline BP of 150/84 (13.9/11.5) mmHg.
Over a 30-year time horizon, the pharmacist-prescribing intervention resulted in 2,100 fewer cases of CV disease (CVD) and eight fewer cases of kidney disease per 10,000 patients. The intervention also led to 0.34 (2.5th-97.5th percentiles, 0.23-0.45) additional life years and 0.62 (2.5th-97.5th percentiles, 0.53-0.73) additional QALYs.
Cost savings were calculated at $10,162 (2.5th-97.5th percentiles; $6,636-$13,581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments.
“The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2,093 to $24,076,” the authors pointed out. “At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years.”
While the findings suggested that a pharmacist-prescribing intervention to improve BP control could provide high economic value, the researchers advised, “The necessary tools and resources are readily available to implement pharmacist-prescribing interventions across the U.S., however, reimbursement limitations remain a barrier.”
Background information in the article notes that hypertension (HTN) is the leading preventable cause of death and disability throughout the world. In the U.S. alone, more than 100 million people have HTN, a significant risk factor for the development of CVD and kidney disease.
“Despite affordable medications and lifestyle interventions proven to reduce blood pressure (BP), BP control rates in the U.S. are declining,” the study pointed out. “Currently, only 1 in 4 adults with HTN has their BP under control (i.e., less than 130/80 mmHg).”
The authors explained that one of the primary strategies is national goals to improve HTN care is to promote standardized treatment approaches and guideline-recommended care with an emphasis on team-based care.
“Pharmacists are well placed in the community to screen and manage HTN because they see patients up to 10 times more frequently than physicians,” according to the researchers. “Numerous randomized clinical trials of pharmacist-led case-finding and prescribing interventions have improved HTN outcomes.”
The article pointed out that widespread implementation of pharmacist-prescribing interventions targeting uncontrolled HTN might be feasible but will require continued advancement in pharmacist scope of practice legislation and eligibility for reimbursement through the Centers for Medicare & Medicaid Services. “Today, 49 states and the District of Columbia have legislative provisions allowing pharmacist prescriptive authority through collaborative practice agreements, standing orders, or statewide protocols,” the authors added. “Such collaborative models often occur between pharmacists and physicians and permit prescriptive authority to pharmacists to initiate, adjust, or discontinue medications for specific medical conditions per an agreed-upon protocol or current clinical practice guidelines.”
The study concluded, “Expansion of prescriptive authority for pharmacists could increase access for those with limited or no source of primary care, which disproportionately affects males, underrepresented minorities, the uninsured, and those living in the southern U.S.”
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