背景:提供医疗保健的挑战在国际上正在发生,并且预计将来还会增加,进一步增加卫生支出。随着药剂师角色在国际上不断发展和扩展,以提供个性化的药学服务,评估这些服务的成本效益非常重要。
目的:系统地综合有关已发表的药学服务经济评估的国际文献,以评估其成本效益和临床结果。
方法:在MEDLINE,EMBASE,PubMed,Scopus,WebofScience,CINAHL,具有搜索功能的IPA和在线期刊可能会发布药学服务的经济评估。提取了有关干预措施的数据,时间的地平线,结果和增量成本效益比。研究报告质量使用综合卫生经济评估报告标准(CHEERS)声明进行评估。
结果:系统评价包括75项研究,包括67项成本效益分析,6项成本效益分析和2项成本后果分析。其中,57人要么占主导地位,要么符合成本效益,使用每QALY46645新西兰元的支付意愿门槛。另有11项研究的成本效益无法评估。被认为最具成本效益的干预措施包括药剂师药物审查,2型糖尿病的药剂师依从性策略和药剂师管理,高血压和华法林/INR监测。研究报告的质量有所不同,没有研究报告CHEERS声明的所有28项。
结论:有强有力的经济证据支持对扩展药剂师服务的投资,特别是那些关注长期慢性健康状况的人。
BACKGROUND: Challenges to the provision of health care are occurring internationally and are expected to increase in the future, further increasing health spending. As pharmacist roles are evolving and expanding internationally to provide individualised pharmaceutical care it is important to assess the cost-effectiveness of these services.
OBJECTIVE: To systematically synthesise the international literature regarding published economic evaluations of pharmacy services to assess their cost-effectiveness and clinical outcomes.
METHODS: A systematic review of economic evaluations of pharmacy services was conducted in MEDLINE, EMBASE, PubMed, Scopus, Web of Science, CINAHL, IPA and online journals with search functions likely to publish economic evaluations of pharmacy services. Data were extracted regarding the interventions, the time horizon, the outcomes and the incremental cost-effectiveness ratio. Studies\' quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement.
RESULTS: Seventy-five studies were included in the systematic review, including 67 cost-effectiveness analyses, 6 cost-benefit analyses and 2 cost-consequence analyses. Of these, 57 were either dominant or cost-effective using a willingness-to-pay threshold of NZ$46 645 per QALY. A further 11 studies\' cost-effectiveness were unable to be evaluated. Interventions considered to be most cost-effective included pharmacist medication reviews, pharmacist adherence strategies and pharmacist management of type 2 diabetes mellitus, hypertension and warfarin/INR monitoring. The quality of reporting of studies differed with no studies reporting all 28 items of the CHEERS statement.
CONCLUSIONS: There is strong economic evidence to support investment in extended pharmacist services, particularly those focussed on long-term chronic health conditions.