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

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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.

Original languageEnglish
Article numbere006874
Number of pages10
JournalBMJ Open
Volume5
Issue number4
DOIs
Publication statusPublished - 1 Apr 2015
Externally publishedYes

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Pharmacists
Chronic Pain
Cost-Benefit Analysis
Primary Health Care
Quality-Adjusted Life Years
Randomized Controlled Trials
Costs and Cost Analysis
Sample Size
Therapeutics
National Health Programs
General Practice
Health Care Costs
General Practitioners
Regression Analysis

Cite this

Neilson, Aileen R ; Bruhn, Hanne ; Bond, Christine M ; Elliott, Alison M ; Smith, Blair H ; Hannaford, Philip C ; Holland, Richard ; Lee, Amanda J ; Watson, Margaret ; Wright, David ; McNamee, Paul. / Pharmacist-led management of chronic pain in primary care : costs and benefits in a pilot randomised controlled trial. In: BMJ Open. 2015 ; Vol. 5, No. 4.
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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.",
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Neilson, AR, Bruhn, H, Bond, CM, Elliott, AM, Smith, BH, Hannaford, PC, Holland, R, Lee, AJ, Watson, M, Wright, D & McNamee, P 2015, 'Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial', BMJ Open, vol. 5, no. 4, e006874. https://doi.org/10.1136/bmjopen-2014-006874

Pharmacist-led management of chronic pain in primary care : costs and benefits in a pilot randomised controlled trial. / Neilson, Aileen R; Bruhn, Hanne; Bond, Christine M; Elliott, Alison M; Smith, Blair H; Hannaford, Philip C; Holland, Richard; Lee, Amanda J; Watson, Margaret; Wright, David; McNamee, Paul.

In: BMJ Open, Vol. 5, No. 4, e006874, 01.04.2015.

Research output: Contribution to journalArticle

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.

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DO - 10.1136/bmjopen-2014-006874

M3 - Article

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JO - BMJ Open

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SN - 2044-6055

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