title: Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial.
abstract: OBJECTIVE
  To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT.
  
  
  METHODS
  Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI).
  
  
  METHODS
  Six general practices: Grampian (3); East Anglia (3).
  
  
  METHODS
  125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months.
  
  
  METHODS
  Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU).
  
  
  METHODS
  Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.
  
  
  RESULTS
  Unadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30,000 and £20,000 per QALY gained, respectively.
  
  
  CONCLUSIONS
  Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups.
  
  
  BACKGROUND
  ISRCTN06131530.
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Aileen R
authors.initials: AR
authors.lastname: Neilson
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: Hanne
authors.initials: H
authors.lastname: Bruhn
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Bond
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Elliott
authors.affiliation: Division of Population Sciences, University of Dundee, Dundee, UK.
authors.forename: Blair H
authors.initials: BH
authors.lastname: Smith
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hannaford
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Holland
authors.affiliation: Medical Statistics Team, University of Aberdeen, Aberdeen, UK.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Watson
authors.affiliation: School of Pharmacy, University of East Anglia, Norwich, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McNamee
mesh_terms: D000700:Analgesics / Q000191:economics; D059350:Chronic Pain / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D011307:Drug Prescriptions / Q000191:economics*; D005260:Female; D058006:General Practice / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D059408:Pain Management / Q000191:economics* / Q000379:methods; D010595:Pharmacists; D010604:Pharmacy; D011320:Primary Health Care; D024382:Professional Role; D019057:Quality-Adjusted Life Years; D059039:Standard of Care / Q000191:economics; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D000700:Analgesics
keywords: HEALTH ECONOMICS; PAIN MANAGEMENT; PRIMARY CARE
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