Incremental cost effectiveness of pharmacist-managed erythropoiesis- stimulating agent clinics for non-dialysis-dependent chronic kidney disease patients

被引：10

作者：

Aspinall S.L. ^{[1
,2
,3
]}

Smith K.J. ^{[4
]}

Good C.B. ^{[1
,2
,3
,7
]}

Zhao X. ^{[2
]}

Stone R.A. ^{[2
,5
]}

Tonnu-Mihara I.Q. ^{[6
]}

Cunningham F.E. ^{[1
]}

机构：

[1] VA Center for Medication Safety, Hines, IL

[2] Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206

[3] School of Pharmacy, University of Pittsburgh, Pittsburgh, PA

[4] Division of Clinical Modeling and Decision Sciences, University of Pittsburgh, Pittsburgh, PA

[5] Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

[6] VA Long Beach Healthcare System, Long Beach, CA

[7] School of Medicine, University of Pittsburgh, Pittsburgh, PA

来源：

Applied Health Economics and Health Policy | 2013年 / 11卷 / 6期

关键词：

Chronic Kidney Disease; Usual Care; Veteran Affair; Usual Care Group; Probabilistic Sensitivity Analysis;

D O I：

10.1007/s40258-013-0057-6

中图分类号：

学科分类号：

摘要：

Background: Pharmacists successfully manage patients with anemia and chronic kidney disease (CKD), but the cost effectiveness of these programs is unknown. Objective: To compare the cost effectiveness of pharmacist-managed erythropoiesis-stimulating agent (ESA) clinics with that of usual care in patients with non-dialysis-dependent (NDD)-CKD. Methods: A Markov model was used to estimate the incremental cost effectiveness of pharmacist-managed ESA clinics compared with usual care in outpatient veterans receiving ESAs for NDD-CKD in 2009. The analysis was conducted from a US Veterans Health Administration perspective with a 5-year time horizon, and the year of valuation for cost results was 2012. The effect of parameter uncertainty was explored in one-way and probabilistic sensitivity analyses. Results: In the deterministic base case analysis, costs and effectiveness per patient over 5 years were US$13,412 and 2.096 quality-adjusted life-years (QALYs) in the pharmacist-managed ESA clinics and US$16,173 and 2.093 QALYs in usual care; ESA clinics dominated usual care. In one-way sensitivity analyses, ESA clinics no longer dominated if their patients' probability of being in the target hemoglobin range fell to 52 % (base case 71 %) or if the mean cost/patient/month of epoetin or darbepoetin in ESA clinics increased to approximately US$382 (base case US$226) or US$477 (base case US$268), respectively. When all parameters were varied simultaneously in a probabilistic sensitivity analysis, ESA clinics were favored ≥80 % of the time at willingness-to-pay thresholds of US$0- $100,000 per QALY gained. Conclusions: Pharmacist-managed ESA clinics were less costly and more effective than usual care in patients receiving ESAs for anemia and NDD-CKD. Results were robust to variation and support the use of pharmacist-managed ESA clinics. © 2013 Springer International Publishing Switzerland (outside the USA).

引用

页码：653 / 660

页数：7

共 20 条

[1]

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