Pharmacist-Led Medication Management Improves Costs in Type 2 Diabetes

A medication-managed (MTM) clinic for patients with type 2 diabetes (T2D) could help reduce health-related costs, according to a study published in Journal of the American Pharmacists Association.¹

Rates of T2D have been increasing in recent years, and are expected to continue to increase. Disease control is complex and expensive, with many associated diseases. The researchers wanted to examine whether drug intervention programs could help reduce the cost of treating T2D.

Since 2001, the University of Illinois Hospital & Health Sciences System (UI Health) has offered a pharmacist-led MTM clinic for patients with T2D who may benefit from medication therapy and disease management support. . Clinically proven MTM improves HbA_1c and systolic blood pressure among these patients. In this study, researchers wanted to examine the cost-effectiveness of an MTM clinic compared to usual care.

The study included 78 participants who received care at the UI Health MTM clinic between 2001 and 2011. Of the participants, 25.6% had no history of T2D-related complications, 3.8% had prior ischemic heart disease (IHD), 12.8% had a history of complications related to T2D. stroke, 5.1% had stroke and myocardial infarction (MI), 23% had heart attack (HF), 6.4% had HF and stroke, 6.4% had renal failure, 5.1% had renal failure and IHD, 1.3% had renal failure and MI, 5.1% were -had renal failure and HF, and 1.3% had renal failure, stroke, and HF. The researchers used a 15-level Markov model for base case analysis. They also evaluated lifetime incremental costs, adjusted life years (QALYs), and disparities.

At baseline, participants in the MTM clinic group incurred $8980 in MTM clinic-related costs, $151,165 in direct medical costs unrelated to the MTM clinic, and 6.73 QALYs. Compared with the usual care group, the MTM clinic group had $1641 less direct medical costs and 0.08 additional QALYs. The researchers calculated an incremental cost-effectiveness ratio (ICER) of $93,375 per QALY gained. With a willingness to pay nearly $100,000, this shows that the program is cost-effective.

READ MORE: Drug Therapy Management: Improving Patient Outcomes and Pharmacy Revenue

To further examine the ICER, the researchers included conditions that exemplified additional complications. In the scenario that included amputation, they calculated an ICER of $83,645 per QALY gained. In the scenario that included blindness, the ICER was $90,229 per QALY gained. The third level assigned 50% of patients to be visited monthly and 50% were visited quarterly after 1 year; The ICER for this event was $63,652.

In sensitivity analyses, the researchers determined which factors had the greatest effect on the ICER. They found that the rate of return per minute for MTM entrepreneurs as well as risk factors for stroke, renal failure, and MI were the most influential.

Despite the clinical success of MTM, researchers have noted that current reimbursement policies for pharmacists are limited, inconsistent, and inadequate.

“Recognizing entrepreneurs as health care providers eligible for direct reimbursement under public and private insurance plans will help provide comprehensive and consistent coverage of medical professionals’ services, ” the researchers wrote.

READ MORE: Diabetes Resource Center

Reference

1. Joshi M, Pham C, Deng H, et al. Clinical Cost-Effectiveness of Pharmacist-Led Medication Management for the Management of Type 2 Diabetes. J Am Pharm Assoc. 2024; e102253. doi:10.1016/j.japh.2024.102253.