Pharmacist-Led Medication Management Improves Cost in Type 2 Diabetes

A pharmacist-led medication therapy management (MTM) clinic for patients with type 2 diabetes (T2D) can help reduce associated healthcare costs, according to a study published in the Journal of the American Pharmacists Association.¹

Rates of T2D have been on the rise in recent years, and they are expected to continue to increase. Disease management is both complex and expensive, with many associated comorbidities. The researchers wanted to explore whether pharmacist intervention programs can help reduce costs in treating T2D.

Pharmacist-led MTM clinics can reduce the costs associated with diabetes management. | image credit: C. Davids/peopleimages.com - stock.adobe.com

Since 2001, the University of Illinois Hospital & Health Sciences System (UI Health) has offered a pharmacist-led MTM clinic to patients with T2D who could benefit from medication therapy and disease management support. The MTM clinic has already proven to improve HbA_1c and systolic blood pressure among these patients. In this study, the researchers wanted to assess the cost-effectiveness of the MTM clinic compared with 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% did not have a history of T2D-related complications, 3.8% had prior ischemic heart disease (IHD), 12.8% had stroke, 5.1% had stroke and myocardial infarction (MI), 23% had heart failure (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% had renal failure and HF, and 1.3% had renal failure, stroke, and HF. The researchers used a 15-state Markov model for base-case analysis. They also evaluated lifetime incremental costs, quality adjusted life-years (QALYs), and ratios.

In the base-case analysis, participants in the MTM clinic cohort incurred $8980 in MTM clinic-related costs, $151,165 in non-MTM clinic-related direct medical costs, and 6.73 QALYs. Compared with the usual care cohort, the MTM clinic cohort had $1641 fewer 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 threshold of $100,000, this indicates the program is cost effective.

READ MORE: Medication Therapy Management: Improving Patient Outcomes and Pharmacy Income

To further assess ICER, the researchers included scenarios that modelled additional complications. In a scenario that included amputation, they calculated an ICER of $83,645 per QALY gained. In a scenario that included blindness, the ICER was $90,229 per QALY gained. A third scenario posited 50% of patients would receive monthly visits and 50% were receive quarterly visits after year 1; the ICER for this scenario was $63,652.

In a sensitivity analyses, the researchers determined which factors had the most significant impact on ICER. They found that the per-minute reimbursement rate for MTM pharmacists as well as the hazard ratios for stroke, renal failure, and MI were the most influential.

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

“Recognizing pharmacists as healthcare providers eligible for direct reimbursement under public and private insurance plans would facilitate broader and more consistent coverage of clinical pharmacist services,” the researchers wrote.

READ MORE: Diabetes Resource Center

Reference

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