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chronic painApril 15 2015

A pilot study has suggested that pharmacist-led interventions for managing chronic pain in primary care could be more expensive than ‘treatment as usual’. There might also be no significant improvement in quality of life measures.

The study, published in BMJ Open, looked at the effect on mean costs of having pharmacist-led management of chronic pain in primary care. It involved 125 patients from six GP practices in Grampian and East Anglia.

In the randomised controlled trial (RCT), the interventions were either treatment as usual by the GP, or patients receiving a pharmacist medication review with face-to-face pharmacist prescribing, or a pharmacist medication review with feedback to the GP.

Outcome measures were differences in mean total costs and effects assessed by the quality life adjusted years (QALY) measure at six months, and the expected value of sample information analysis (EVSI) - an estimate of potential improvement based on limited data.

The authors found that pharmacist-led medication review with or without prescribing in patients with chronic pain in primary care “had similar effects in terms of QALYs compared with treatment as usual but was more expensive.”

However, they add: “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.” A future study could require potentially up to 780 patients per study group.

Results from the pilot study show that the unadjusted total mean costs per patient were £452 for the prescribing intervention, £570 for the medication review, and £668 for treatment as usual. However, when baseline costs were taken into account, the adjusted mean cost differences per patient relative to treatment as usual were £77 for prescribing and £54 for review.

When looking at quality of life, both pharmacist-led intervention arms generated slightly more QALYs than treatment as usual, but the magnitude of QALY gains were small (approximately 0.01 extra QALYs relative to treatment as usual) in both cases.

“The results suggested that the pharmacist interventions were likely to be more costly than treatment as usual when differences in costs at baseline were taken into account, but there was a large degree of uncertainty surrounding the estimates of differences in mean costs and mean effects (ie, QALYs),” says the report.

“Given this uncertainty, the economic case for pharmacist prescribing with or without review over treatment as usual can only be established with a larger RCT. The potential gain from a future trial was estimated by the EVSI; this showed that the gains in monetary terms from a future trial exceed the expected costs.”

Link:

‘Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial’. AR Neilson et al. BMJ Open 2015;5:e006874. Published online April 1 2015    

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