title: Does pharmacist-supervised intervention through pharmaceutical care program influence direct healthcare cost burden of newly diagnosed diabetics in a tertiary care teaching hospital in Nepal: a non-clinical randomised controlled trial approach.
abstract: BACKGROUND
  Cost is a vital component for people with chronic diseases as treatment is expected to be long or even lifelong in some diseases. Pharmacist contributions in decreasing the healthcare cost burden of chronic patients are not well described due to lack of sufficient evidences worldwide. In developing countries like Nepal, the estimation of direct healthcare cost burden among newly diagnosed diabetics is still a challenge for healthcare professionals, and pharmacist role in patient care is still theoretical and practically non-existent. This study reports the impact of pharmacist-supervised intervention through pharmaceutical care program on direct healthcare costs burden of newly diagnosed diabetics in Nepal through a non-clinical randomised controlled trial approach.
  
  
  METHODS
  An interventional, pre-post non-clinical randomised controlled study was conducted among randomly distributed 162 [control (n = 54), test 1 (n = 54) and test 2 (n = 54) groups] newly diagnosed diabetics by a consecutive sampling method for 18 months. Direct healthcare costs (direct medical and non-medical costs) from patients perspective was estimated by 'bottom up' approach to identify their out-of-pocket expenses (1USD = NPR 73.38) before and after intervention at the baseline, 3, 6, 9 and 12 months follow-ups. Test groups' patients were nourished with pharmaceutical care intervention while control group patients only received care from physician/nurses. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences in direct healthcare costs among the groups before and after the intervention (p ≤ 0.05).
  
  
  RESULTS
  Friedman test identified significant differences in direct healthcare cost of test 1 (p < 0.001) and test 2 (p < 0.001) groups patients. However, Mann-Whitney U test justified significant differences in direct healthcare cost between control group and test 1 group, and test 2 group patients at 6-months (p = 0.009, p = 0.010 respectively), 9-months (p = 0.005, p = 0.001 respectively) and 12-months (p < 0.001, p < 0.001 respectively).
  
  
  CONCLUSIONS
  Pharmacist supervised intervention through pharmaceutical care program significantly decreased direct healthcare costs of diabetics in test groups compared to control group and hence describes pharmacist's contribution in minimizing direct healthcare cost burden of patients.
authors.affiliation: Faculty of Pharmacy, Asian Institute of Medicine, Science and Technology University, Jalan Bedong-Semeling, 08100, Bedong, Kedah, Malaysia.
authors.forename: Dinesh Kumar
authors.initials: DK
authors.lastname: Upadhyay
authors.affiliation: Social and Administrative Pharmacy, College of Pharmacy, Qatar University, 2713, Doha, Qatar.
authors.forename: Mohamed Izham Mohamed
authors.initials: MI
authors.lastname: Ibrahim
authors.affiliation: Department of Pharmacology, American University of the Caribbean School of Medicine, 1 University Drive at Jordan Road, Cupecoy, St. Maarten, Netherlands Antilles.
authors.forename: Pranaya
authors.initials: P
authors.lastname: Mishra
authors.affiliation: Department of Medicine, Manipal College of Medical Sciences and Manipal Teaching Hospital, Phulbari-11, Pokhara, Nepal.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Alurkar
authors.affiliation: Department of Pharmacy and Pharmacology, National Medical College, Birgunj, Nepal. mukhtaransari@hotmail.com.
authors.forename: Mukhtar
authors.initials: M
authors.lastname: Ansari
mesh_terms: D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D009390:Nepal; D010595:Pharmacists; D011897:Random Allocation; D063128:Tertiary Health Care