title: Improving adherence to lipid-lowering therapy in a community pharmacy intervention program: a cost-effectiveness analysis.
abstract: BACKGROUND
  Pharmaceutical care in community pharmacies has been shown to improve adherence to chronic therapies. Long-term impact on clinical outcomes or medical cost savings, however, remains understudied.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of a pharmaceutical care intervention program in Dutch community pharmacies that improved patients' adherence to lipid-lowering therapy.
  
  
  METHODS
  An economic evaluation was performed using a time-dependent Markov model from the health care payer perspective. Participants were patients initiating lipid-lowering therapy for primary prevention (40%) or secondary prevention (60%) of cardiovascular events (CVEs). The intervention was the pharmaceutical care program MeMO (Medication Monitoring and Optimisation) in 9 community pharmacies in the Netherlands, based on continuous monitoring and optimization of lipid-lowering therapy in new patients. The follow-up period of the program was 1 year. The main outcome of the intervention program was discontinuation of lipid-lowering therapy. This outcome was extrapolated in the economic model to lifelong costs, quality of life, reductions in cardiovascular events, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  Patients in the MeMO program had a lower risk for therapy discontinuation, RR = 0.49 (0.37 to 0.66); the effectiveness was similar in primary and secondary prevention. In a cohort of 1,000 primary and secondary prevention patients, the MeMO program resulted in a reduction of 7 nonfatal strokes, 2 fatal strokes, 16 nonfatal myocardial infarctions (MIs), 7 fatal MIs, and 16 revascularizations over patients' lifetime. Additional medication, disease management, and intervention costs in the MeMO program were €411,000; the cost savings due to reduced CVEs were €443,000. The MeMO program resulted in 84 quality-adjusted life-years (QALYs) gained and net cost savings of €32,000. Clinical benefits and cost savings were highest in the secondary prevention population.
  
  
  CONCLUSIONS
  Pharmaceutical care in community pharmacies can improve statin therapy adherence, resulting in better prevention of CVEs. The MeMO program resulted in considerable clinical benefits and net cost savings. Programs by community pharmacies targeted at improving adherence may provide good value for money, and health care insurers should consider reimbursing these activities.
authors: University of Groningen, 9713 AV, Groningen, Netherlands. s.vegter@rug.nl.
authors: Stefan
authors: S
authors: Vegter
authors: Piter
authors: P
authors: Oosterhof
authors: Job F M
authors: JF
authors: van Boven
authors: Ada G G
authors: AG
authors: Stuurman-Bieze
authors: Eric G
authors: EG
authors: Hiddink
authors: Maarten J
authors: MJ
authors: Postma
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003157:Community Pharmacy Services / Q000191:economics / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D055118:Medication Adherence; D008875:Middle Aged; D018803:Models, Economic; D009426:Netherlands; D011322:Primary Prevention / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors
chemical_list: D000960:Hypolipidemic Agents