title: Cost-benefit and cost-savings analyses of antiarrhythmic medication monitoring.
abstract: OBJECTIVE
  The economic impact of pharmacist-managed antiarrhythmic drug therapy monitoring on an academic medical center's electrophysiology (EP) program was investigated.
  
  
  METHODS
  Data were collected for the initial two years of patient visits (n = 816) to a pharmacist-run clinic for antiarrhythmic drug therapy monitoring. A retrospective cost analysis was conducted to assess the direct costs associated with three appointment models: (1) a clinic office visit only, (2) a clinic visit involving electrocardiography and basic laboratory tests, and (3) a clinic visit including pulmonary function testing and chest x-rays in addition to electrocardiography and laboratory testing. A subset of patient cases (n = 18) were included in a crossover analysis comparing pharmacist clinic care and usual care in an EP physician clinic. The primary endpoints were the cost benefits and cost savings associated with pharmacy-clinic care versus usual care. A secondary endpoint was improvement of overall EP program efficiency.
  
  
  RESULTS
  The payer mix was 61.6% (n = 498) Medicare, 33.2% (n = 268) managed care, and 5.2% (n = 42) other. Positive contribution margins were demonstrated for all appointment models. The pharmacist-managed clinic also yielded cost savings by reducing overall patient care charges by 21% relative to usual care. By the second year, the pharmacy clinic improved EP program efficiency by scheduling an average of 24 patients per week, in effect freeing up one day per week of EP physician time to spend on other clinical activities.
  
  
  CONCLUSIONS
  Pharmacist monitoring of antiarrhythmic drug therapy in an out-patient clinic provided cost benefits, cost savings, and improved overall EP program efficiency.
authors.affiliation: The Ohio State University Wexner Medical Center, Ross Ambulatory Care Center, 452 West 10th Avenue, Columbus, OH 43210, USA. melissa.snider@osumc.edu
authors.forename: Melissa
authors.initials: M
authors.lastname: Snider
authors.forename: Cynthia
authors.initials: C
authors.lastname: Carnes
authors.forename: Janel
authors.initials: J
authors.lastname: Grover
authors.forename: Rich
authors.initials: R
authors.lastname: Davis
authors.forename: Steven
authors.initials: S
authors.lastname: Kalbfleisch
mesh_terms: D000046:Academic Medical Centers; D000889:Anti-Arrhythmia Agents / Q000191:economics / Q000627:therapeutic use*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D016903:Drug Monitoring / Q000191:economics / Q000379:methods*; D055724:Electrophysiological Phenomena; D017048:Health Care Costs; D006801:Humans; D005791:Patient Care / Q000191:economics / Q000379:methods; D010593:Pharmaceutical Services / Q000191:economics / Q000458:organization & administration*; D010595:Pharmacists / Q000191:economics / Q000458:organization & administration*; D012189:Retrospective Studies
chemical_list: D000889:Anti-Arrhythmia Agents