Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review.

There has been growing interest in integrating digital technologies in healthcare. The purpose of this study was to systematically review the economic value of pharmacist-led digital interventions. PubMed, Web of Science, and the Cochrane databases were searched to select studies that had conducted economic evaluations of digital interventions by pharmacists for the period from January 2001 to February 2022. Economic evidence from 14 selected studies was synthesized in our analysis. Pharmacists used telephones, computers, web-based interventions, videotapes, smartphones, and multiple technologies for their digital interventions. Prior studies have reported the results of telephone-based interventions to be cost-effective. Alternatively, these interventions were found to be cost-effective when reevaluated with recently cited willingness-to-pay thresholds. In addition, pharmacist-led interventions based on computers, web-based interventions, smartphones, and multiple technologies have been reported to be cost-effective in previous studies. However, videotape-based intervention was found cost-ineffective because there was no significant difference in outcomes between the intervention and the usual care groups. If this intervention had been intensive enough to improve outcomes in the intervention group, favorable cost-effectiveness results could have been obtained. The economic evidence in the previous studies represented short-term economic values. Economic evaluations of the long-term value of digital interventions are warranted in future studies.

Comparative risk of musculoskeletal adverse reactions among new users of dipeptidyl peptidase-4 inhibitors: A retrospective cohort study.

Background: The effects of dipeptidyl peptidase-4 inhibitors (DPP4Is) on joint pain have been controversial. Objective: To assess the comparative musculoskeletal (MSk) risk of DPP4Is vs. non-DPP4Is. Methods: This study used a national claims database from January 2007 to December 2014. Exposure included the initiation of DPP4Is against the initiation of non-DPP4Is: metformin, sulfonylureas, thiazolidinediones, meglitinides, and glucagonlike peptide-1 receptor agonists (GLP-1 RAs). Insulin was not included in this study. Outcomes were newly diagnosed MSk conditions (arthralgia, arthropathy, and rheumatoid arthritis or other inflammatory polyarthropathies). Individuals exposed to DPP4Is were matched to those exposed to non-DPP4Is using a propensity score (PS). Balance between the DPP4I's group and the non-DPP4I's group was assessed using standardized differences for both continuous and categorical variables. Cox regressions were used to estimate hazard ratios (HRs) for MSk conditions. Results: Among PS-matched cohorts, incidence rates (IRs) for MSk conditions did not differ between DPP4I initiators and non-DPP4I initiators (HR = 1.01, 95% CI: 0.97-1.05). After stratifying non-DPP4Is by drug class, the results still showed that DPP4I initiators had similar MSk risk when compared to initiators of metformin, sulfonylureas, meglitinides, and GLP-1 RAs. However, thiazolidinedione initiators had higher risk of MSk conditions than DPP4I initiators (HR = 1.05, 95% CI: 1.00-1.10). Conclusions: This head-to-head comparison study estimated comparative MSk risks among different antidiabetic drugs. The risk of MSk conditions among DPP4I initiators were not significantly higher than non-DPP4I initiators.

Direct to Consumer Telemedicine: Is Healthcare From Home Best?

Direct-to-consumer (DTC) telemedicine is increasingly popular and enables patients to obtain medical advice and treatment via electronic media (e.g., computer, telephone, or smartphone) without a prior doctor-patient relationship. Convenience, accessibility, and home delivery make DTC telemedicine attractive to patients. Concerns about DTC telemedicine include: a lack of regulation, transparency, and an established patient-provider relationship (physician and pharmacist). In future, researchers, providers, and insurers need to better understand the concerns and challenges that this new form of healthcare poses.

Comparative effectiveness of lipid-lowering treatments to reduce cardiovascular disease.

INTRODUCTION: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor is a new treatment option for patients with hypercholesterolemia. The objective of this study was to systematically review the cost-effectiveness of lipid-lowering agents. AREAS COVERED: Based on Pubmed, Embase, and Cochrane Database of Systematic Reviews, we identified 29 relevant articles. Studies found statins were cost-effective compared with placebo or no treatment in general. Atorvastatin was reported to be cost-effective against simvastatin. In most cases, rosuvastatin was more cost-effective than atorvastatin or simvastatin. Additionally, ezetimibe was considered to be cost-effective compared with no treatment for statin intolerant patients. For patients not meeting treatment goals with their statins, switching to ezetimibe plus simvastatin was consistently reported cost-effective. The cost-effectiveness of ezetimibe plus a hybrid of a statin varied by the source of clinical data and cost of ezetimibe. Finally, the cost-effectiveness of PCSK9 inhibitor plus a statin against statin monotherapy was uncertain. The PCSK9 inhibitor plus a stain was cost-ineffective compared with ezetimibe plus a statin. EXPERT COMMENTARY: Drug costs and treatment efficacy were the key drivers of the cost-effectiveness results in prior analyses. Future evaluations are warranted to reflect the decreasing drug prices and the long-term treatment effects of PCSK9 inhibitors.

Characteristics of patients using specialty medications.

BACKGROUND: Specialty medications include innovative drugs and biologic agents requiring special handling and close monitoring. Although specialty medications have been widely used for various chronic conditions, increased use of these medications has contributed a growing share of total health care expenditures. OBJECTIVE: The aim of this study was to examine patient characteristics related to specialty medication use. METHODS: Using Medical Expenditure Panel Survey (MEPS) data from 2000 through 2013, this study identified U.S. adults using specialty medications. Andersen's Health Services Utilization model was used to identify potential factors related to specialty medication use. Associations between the variables identified by Andersen's model and specialty medication use were analyzed using logistic multilevel modelling. Sampling weights were considered and standard errors were adjusted to account for the complex survey design. RESULTS: A fully adjusted model suggested that older adults, individuals with prescription drug insurance, or those using mail order services were more likely to use specialty medications regardless of whether they used traditional medications concurrently. Behaviors of using specialty medications were positively associated with married and active working status and negatively associated with middle or high income and having a usual source of care (visiting a doctor's office, clinic, or health center when sick) when comparing individuals using traditional medications and those using specialty medications. In addition, when comparing individuals using traditional medications with those using both specialty medications and traditional medications, behaviors of using specialty medications were positively associated with female gender, worse health state, and more comorbidities. CONCLUSION: This study identified characteristics of patients using specialty medications. Some sociodemographic, economic, and clinical factors were related to specialty medication use among U.S. adults.

Cost Effectiveness of Monoclonal Antibody Therapy for Rare Diseases: A Systematic Review.

BACKGROUND: Monoclonal antibody (mAb)-based orphan drugs have led to advances in the treatment of diseases by selectively targeting molecule functions. However, their high treatment costs impose a substantial cost burden on patients and society. OBJECTIVES: The study aimed to systematically review cost-effectiveness evidence of mAb orphan drugs. METHODS: Ovid MEDLINE(®), EMBASE(®), and PsycINFO(®) were searched in June 2014 and articles were selected if they conducted economic evaluations of the mAb orphan drugs that had received marketing approval in the USA. The quality of the selected studies was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS: We reviewed 16 articles that included 24 economic evaluations of nine mAb orphan drugs. Six of these nine drugs were included in cost-utility analysis studies, whereas three drugs were included in cost-effectiveness analysis studies. Previous cost-utility analysis studies revealed that four mAb orphan drugs (cetuximab, ipilimumab, rituximab, and trastuzumab) were found to be cost effective; one drug (bevacizumab) was not cost effective; and one drug (infliximab) was not consistent across the studies. Prior cost-effectiveness analysis studies which included three mAb orphan drugs (adalimumab, alemtuzumab, and basiliximab) showed that the incremental cost per effectiveness gained for these drugs ranged from $US4669 to $Can52,536 Canadian dollars. The quality of the included studies was good or fair with the exception of one study. CONCLUSIONS: Some mAb orphan drugs were reported as cost effective under the current decision-making processes. Use of these expensive drugs, however, can raise an equity issue which concerns fairness in access to treatment. The issue of equal access to drugs needs to be considered alongside other societal values in making the final health policy decisions.

Texas community pharmacists' willingness to participate in pharmacist-initiated emergency contraception.

OBJECTIVES: To determine Texas community pharmacists' knowledge about and experience with emergency contraception (EC), their perceptions about and willingness to participate in pharmacist-initiated emergency contraception (PIEC), and whether their willingness is influenced by their background characteristics or experience with EC. DESIGN: Cross-sectional study. SETTING: Texas in November through December 2004. PARTICIPANTS: 300 community pharmacists. INTERVENTIONS: Mailed questionnaire consisting of 40 questions divided into three SECTIONS: experience with EC, perceptions about PIEC, and background information. MAIN OUTCOME MEASURES: Pharmacists' perceptions and behaviors regarding EC and PIEC, and their willingness to participate in PIEC. Bivariate analysis to assess background characteristics and experience with EC in relation to willingness to participate in PIEC; multiple regression to identify predictors of willingness to participate in PIEC. RESULTS: With a usable response rate of 51%, results indicate that most pharmacists (91.2%) had heard of EC, while 45.2% kept EC in stock. More than one half (57.8%) had dispensed EC, and 95.5% were aware that EC is most effective when taken within 72 hours. Some 27.4% were opposed to dispensing EC, primarily because of religious (86.1%) and moral (80.6%) beliefs. Most (57.7%) believed that there should be a minimum age (mean +/- SD, 17.25 +/- 1.93 years) for patients receiving EC. Less than one half (46.7%) had heard of PIEC. Although pharmacists agreed (3.42 +/- 1.38) that PIEC would enhance the role of community pharmacists, they were unwilling (2.71 +/- 1.54) to participate in PIEC. Significant predictors of willingness to participate in PIEC included background characteristics, experience with EC, as well as benefits and barriers associated with PIEC. A regression analysis indicated that these significant predictors accounted for 58.6% of the total variance in willingness to participate in PIEC. CONCLUSION: A majority of Texas community pharmacists were quite knowledgeable about and aware of EC, but fewer had actually dispensed EC. Most had not heard of PIEC before study participation, and their perceptions relating to PIEC were generally unfavorable. Potential barriers to PIEC outnumbered potential benefits for most pharmacists. Findings indicate that Texas community pharmacists were not willing to become involved in PIEC at the time of this study.