Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial

Aileen R Neilson; Hanne Bruhn; Christine M Bond; Alison M Elliott; Blair H Smith; Philip C Hannaford; Richard Holland; Amanda J Lee; Margaret Watson; David Wright; Paul McNamee

doi:10.1136/bmjopen-2014-006874

Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial

Aileen R Neilson, Hanne Bruhn, Christine M Bond, Alison M Elliott, Blair H Smith, Philip C Hannaford, Richard Holland, Amanda J Lee, Margaret Watson, David Wright, Paul McNamee

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

OBJECTIVES: To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT.

DESIGN: Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI).

SETTING: Six general practices: Grampian (3); East Anglia (3).

PARTICIPANTS: 125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months.

INTERVENTIONS: Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU).

MAIN OUTCOME MEASURES: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.

RESULTS: Unadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30,000 and £20,000 per QALY gained, respectively.

CONCLUSIONS: Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups.

TRIAL REGISTRATION NUMBER: ISRCTN06131530.

Original language	English
Pages (from-to)	e006874
Journal	BMJ Open
Volume	5
Issue number	4
DOIs	https://doi.org/10.1136/bmjopen-2014-006874
Publication status	Published - 1 Apr 2015

Keywords / Materials (for Non-textual outputs)

Analgesics/economics
Chronic Pain/drug therapy
Cost-Benefit Analysis
Drug Prescriptions/economics
Female
General Practice/economics
Health Care Costs
Humans
Intention to Treat Analysis
Male
Pain Management/economics
Pharmacists
Pharmacy
Primary Health Care
Professional Role
Quality-Adjusted Life Years
Standard of Care/economics
State Medicine
Surveys and Questionnaires
United Kingdom

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10.1136/bmjopen-2014-006874

https://bmjopen.bmj.com/content/5/4/e006874

Cite this

@article{53fad003a6eb4a7bacbb7a38e4a8ed31,

title = "Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial",

abstract = "OBJECTIVES: To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT.DESIGN: Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI).SETTING: Six general practices: Grampian (3); East Anglia (3).PARTICIPANTS: 125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months.INTERVENTIONS: Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU).MAIN OUTCOME MEASURES: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.RESULTS: Unadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30,000 and £20,000 per QALY gained, respectively.CONCLUSIONS: Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups.TRIAL REGISTRATION NUMBER: ISRCTN06131530.",

keywords = "Analgesics/economics, Chronic Pain/drug therapy, Cost-Benefit Analysis, Drug Prescriptions/economics, Female, General Practice/economics, Health Care Costs, Humans, Intention to Treat Analysis, Male, Pain Management/economics, Pharmacists, Pharmacy, Primary Health Care, Professional Role, Quality-Adjusted Life Years, Standard of Care/economics, State Medicine, Surveys and Questionnaires, United Kingdom",

author = "Neilson, {Aileen R} and Hanne Bruhn and Bond, {Christine M} and Elliott, {Alison M} and Smith, {Blair H} and Hannaford, {Philip C} and Richard Holland and Lee, {Amanda J} and Margaret Watson and David Wright and Paul McNamee",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",

year = "2015",

month = apr,

day = "1",

doi = "10.1136/bmjopen-2014-006874",

language = "English",

volume = "5",

pages = "e006874",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "4",

}

TY - JOUR

T1 - Pharmacist-led management of chronic pain in primary care

T2 - costs and benefits in a pilot randomised controlled trial

AU - Neilson, Aileen R

AU - Bruhn, Hanne

AU - Bond, Christine M

AU - Elliott, Alison M

AU - Smith, Blair H

AU - Hannaford, Philip C

AU - Holland, Richard

AU - Lee, Amanda J

AU - Watson, Margaret

AU - Wright, David

AU - McNamee, Paul

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - OBJECTIVES: To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT.DESIGN: Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI).SETTING: Six general practices: Grampian (3); East Anglia (3).PARTICIPANTS: 125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months.INTERVENTIONS: Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU).MAIN OUTCOME MEASURES: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.RESULTS: Unadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30,000 and £20,000 per QALY gained, respectively.CONCLUSIONS: Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups.TRIAL REGISTRATION NUMBER: ISRCTN06131530.

AB - OBJECTIVES: To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT.DESIGN: Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI).SETTING: Six general practices: Grampian (3); East Anglia (3).PARTICIPANTS: 125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months.INTERVENTIONS: Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU).MAIN OUTCOME MEASURES: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.RESULTS: Unadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30,000 and £20,000 per QALY gained, respectively.CONCLUSIONS: Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups.TRIAL REGISTRATION NUMBER: ISRCTN06131530.

KW - Analgesics/economics

KW - Chronic Pain/drug therapy

KW - Cost-Benefit Analysis

KW - Drug Prescriptions/economics

KW - Female

KW - General Practice/economics

KW - Health Care Costs

KW - Humans

KW - Intention to Treat Analysis

KW - Male

KW - Pain Management/economics

KW - Pharmacists

KW - Pharmacy

KW - Primary Health Care

KW - Professional Role

KW - Quality-Adjusted Life Years

KW - Standard of Care/economics

KW - State Medicine

KW - Surveys and Questionnaires

KW - United Kingdom

U2 - 10.1136/bmjopen-2014-006874

DO - 10.1136/bmjopen-2014-006874

M3 - Article

C2 - 25833666

SN - 2044-6055

VL - 5

SP - e006874

JO - BMJ Open

JF - BMJ Open

IS - 4

ER -

Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

Access to Document

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