COST EFFECTIVENESS OF THE NEW MEDICINE SERVICE IN COMMUNITY PHARMACIES IN ENGLAND
We aimed to estimate cost-effectiveness of a community-pharmacy service to improve adherence to new medicines for long-term-conditions, compared with current practice, by combining effectiveness in adherence improvement and intervention costs from an RCT with modelled effects of adherence on patient outcomes and healthcare costs, to estimate the effect on costs and quality-adjusted-life-years (QALYs).
The New Medicine Service (NMS) is offered by community-pharmacists in England to people starting a new medicine for asthma/ chronic obstructive pulmonary disease (COPD), type 2 diabetes (T2D), hypertension or antiplatelet/anticoagulant treatment to help improve medicines adherence. We conducted a robust, pragmatic patient-level RCT, the primary outcome was adherence at 10 weeks (defined as Morisky Medication Adherence Score, MMAS-8 ≥ 6). We undertook the economic analysis from the perspective of NHS England with a lifetime time-horizon.
We developed Markov models for each therapeutic area, using the most commonly prescribed drug in each to inform model design. Clinical event probability, treatment pathway, resource-use and costs were extracted from literature and English costing tariffs. Lifetime cost and QALYs were derived from each medicine-specific model, for adherent and non-adherent patients. A composite probabilistic model combined patient-level adherence models with adherence rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated.
504 patients (253 current practice; 251 NMS intervention) were recruited from 46 pharmacies. 249 (49.4%) had hypertension, 117 (23.2%) asthma/COPD; 95 (18.8%) T2D; 43 (8.5%) antiplatelet/anticoagulant treatment. At Week 10 there was a significant adherence improvement in NMS arm, compared to current practice, with adjusted odds ratio 1.81 (95%CI: 1.07-3.05, p=0.03).
Mean (median, range) NHS cost at 10 weeks for patients in current practice and NMS are £260 (121, 0-1668), and £215 (110,0-1458), respectively, suggesting NMS service costs were countered by reduced NHS contact costs.
NMS generated a mean of 0.06 (95%CI: 0.00-0.16) more QALYs per patient, at a mean reduced cost of £-190 (-929-87). The NMS service dominates current practice, with an ICER (95% credibility range) of -£3,005 (-17,212-4,542). Probabilistic analysis suggests the probability that NMS dominates current practice is 0.81. NMS has a high probability (0.97) of cost-effectiveness at a willingness-to-pay of £20,000/QALY.
NMS increased health gain at a cost per QALY well below most accepted UK thresholds for technology implementation, £20,000-£30,000.