Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes

Abstract

Background

Diabetes imposes a substantial public health burden. Involvement of clinical pharmacists in diabetes disease management can improve health outcomes while managing expenditure.

Objective

This study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus, from a U.S. payer perspective.

Methods

A cohort simulation Markov model was developed to simulate the occurrence of major complications of diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities were based on data from electronic health records and published literature. Outcomes evaluated were lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effective ratio (ICER). Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes, and of reduced MTMC visit frequency.

Results

Over a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The ICER for MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure.

Conclusion

The study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term health care costs.