Cost-Effectiveness of Pharmacist Care in Diabetes Management: A Systematic Review.

INTRODUCTION: In recent years, the role of pharmacists has undergone significant transformation to become more patient-centered and involved in managing chronic diseases. Nonetheless, it remains unclear whether pharmacist involvement in diabetes management is cost-effective. This study aimed to systematically review the cost-effectiveness and reporting quality in comprehensive economic evaluations of pharmacist management compared to standard care in diabetes. METHODS: Eligible studies included cost-effectiveness analyses employing pharmacist professional services as the intervention for diabetes. A literature search was conducted in the bibliographic databases Pubmed, Scopus, China National Knowledge Infrastructure (CNKI), and the International Health Technology Assessment (HTA) database from their inception until July 2023. Two independent reviewers performed title, abstract, full-text screening, and data abstraction and assessed the quality of reporting and methodological approaches using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklists. RESULTS: Twelve studies were identified with an average research quality score of 19.8, including cost-utility (n = 5) and cost-effectiveness (n = 7) analyses, with only four studies rated as high quality. The efficacy data were derived from randomized controlled trials (n = 7), retrospective studies (n = 2), and published literature sources (n = 2). Half of the included studies were conducted in high-income countries, while the other half was in upper-middle and lower-middle-income countries, respectively. Despite significant variations in the cost of pharmacist intervention, consistent findings demonstrate that pharmacist involvement in diabetes management is more cost-effective or even cost-saving than standard care, primarily attributed to better glycemic control, enhanced patient compliance, and reduced risks of medication-related problems. CONCLUSION: This systematic review substantiates that pharmacist involvement in diabetes management is cost-effective compared with standard care. However, the overall quality of reporting needs to be improved, and high-quality evidence is urgently needed to support healthcare decision-making in pharmacy practice.

Cost-Effectiveness of Newer Antidiabetic Drugs as Second-Line Treatment for Type 2 Diabetes: A Systematic Review.

INTRODUCTION: Evidence from cardiovascular outcome trials (CVOTs) for newer antidiabetic drugs is increasingly influencing revised recommendations for second-line therapy in type 2 diabetes (T2D). This systematic review aimed to compare the cost-effectiveness of newer antidiabetic drugs specified as sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide 1 receptor agonist (GLP-1RA), and dipeptidyl peptidase 4 inhibitor (DPP-4i) for T2D in a second-line setting. METHODS: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, and all relevant published studies were searched comprehensively in electronic databases, including PubMed, Embase, Web of Science, and International Health Technology Assessment database published from April 2023. The quality of the included studies was evaluated using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 reporting checklists. RESULTS: We included 28 studies that met the inclusion criteria. Overall reporting of the identified studies largely met CHEERS 2022 recommendations. The CORE and Cardiff models were the most frequently utilized for pharmacoeconomic evaluation in T2D. Four studies consistently discovered that SGLT2i was more cost-effective than GLP-1RA in T2D who were not adequately controlled by metformin monotherapy. Four studies compared GLP-1RA with DPP-4i, sufonylurea (SU), or insulin. Except for one that demonstrated SU was cost-effective, all were GLP-1RA. Five studies revealed that SGLT2i was more cost-effective than DPP-4i or SU. Eleven studies indicated that DPP-4i was more cost-effective than traditional antidiabetic drugs. Four additional studies explored the cost-effectiveness of various antidiabetic drugs as second-line options, indicating that SU, SGLT2i, or meglitinides were more economically advantageous. The most common driven factors were the cost of new antidiabetic drugs. CONCLUSION: Newer antidiabetic drugs as second line are the cost-effective option for T2D from the cost-effectiveness perspective, especially SGLT2i.

A pharmacoeconomic evaluation of the pharmacotherapeutic options for painful diabetic neuropathy.

INTRODUCTION: Painful diabetic neuropathy (PDN) is a high incidence and severe complication of diabetes mellitus, significantly compromising patients' quality of life and causing tremendous economic burden. Considering drug costs becomes part of treatment decisions, with the growing choice of monotherapy or combination treatment strategies for PDN treatment. AREAS COVERED: This systematic review aims to identify the cost-effectiveness of pharmacotherapies in PDN, summarize key findings, and assess the quality of studies to inform healthcare resource allocation decisions and future research. Economic evaluations were identified by searching PubMed, Web of Science, Scopus and health technology assessment (HTA) databases, as well as screening reference lists of previously identified studies. Relevant data was extracted, and the CHEERS checklist was used to assess the quality of the studies. EXPERT OPINION: Collectively, the findings indicate that more pharmacoeconomics research is urgently needed to directly compare high-quality research for PDN combination medication/sequential treatment, and which is performed from a societal perspective. Simultaneously, to strengthen the reliability of the analysis, metrics such as adherence, incidence of adverse drug reactions, and pain levels utility value should be examined to verify the robustness of the basic results.