Pharmacist prescribing to improve blood pressure control provides high economic value

A new economic analysis suggests that pharmacist-prescribing interventions to optimize blood pressure control would result in significant savings for the U.S. healthcare system. The study was a collaborative effort involving researchers in the U.S., Canada and New Zealand.1The economic evaluation employed a five-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (RxACTION) (2009–2013).2 Pharmacist prescribing involved pharmacist assessment and counselling on blood pressure, antihypertensive medication review and prescribing antihypertensives. Control group patients received a blood pressure wallet card, education and usual care.1Results showed the following:Over a 30-year time period, the pharmacist-prescribing intervention yielded 2,100 fewer cases of cardiovascular disease and eight fewer cases of kidney disease per 10,000 patients. The intervention was associated with 0.34 (2.5th–97.5th percentiles, 0.23–0.45) additional life years and 0.62 (2.5th–97.5th percentiles, 0.53–0.73) additional quality-adjusted life years. The cost savings were $10,162 (2.5th–97.5th percentiles, $6,636–$13,581) per person due to fewer cardiovascular events with the pharmacist-prescribing intervention, even after incorporating the cost of visits and medication adjustments. At the population level, a 50% uptake of the pharmacist-prescribing intervention was projected to be associated with $1.137 trillion (US) in cost savings and save an estimated 30.2 million life-years over a 30-year period. These savings would largely be attributable to a reduction in cardiovascular events due to improved blood pressure control with the pharmacist-prescribing intervention.1 The findings of this simulated cost-effectiveness analysis suggest that widespread implementation of a pharmacist-prescribing intervention to improve blood pressure control in the U.S. has the potential to provide high economic value. The authors acknowledge that their study had some limitations. For example, cost savings were based on a 50% uptake of the intervention, and the degree of savings would depend on uptake. In addition, the model assumed that blood pressure control did not change in the control group, although it may have improved with usual care in a portion of patients in this group.The authors point out that there is a critical need for innovative approaches—such as pharmacist-led interventions—to improve blood pressure control, as hypertension-related mortality and shortages of primary care clinicians in the U.S. continue to rise. The necessary tools (e.g., collaborative practice agreements, treatment algorithms) and resources (e.g., patient access to community pharmacists) are readily available to implement pharmacist-prescribing interventions to optimize blood pressure in the U.S., but reimbursement limitations remain a barrier.1References1. Dixon DL, Johnston K, Patterson J, et al. Cost-effectiveness of pharmacist prescribing for managing hypertension in the United States. JAMA Network Open 2023;6(11):e2341408. (accessed December 7, 2023).2. Marra C, Johnston K, Santschi V, et al. Cost-effectiveness of pharmacist care for managing hypertension in Canada. Can Pharm J 2017;150(3):184-97. (accessed December 7, 2023).

Pharmacist prescribing to improve blood pressure control provides high economic value

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