The cost-effectiveness of pharmacist-led treatment of cardiac risk in patients with type 2 diabetes
- 301 Downloads
People with type 2 diabetes mellitus have an increased risk of cardiovascular and cerebrovascular disease compared with the general population. Following attempts to change lifestyle, pharmacological treatment is necessary to modify this risk. However, the use of medicines may be sub-optimal because of infrequent or inadequate medication review.
Harrogate District Hospital, a medium-sized district general hospital in a rural area of North Yorkshire, England.
A pharmacist-led hospital clinic was established to manage diabetic patients suffering from resistant hypertension with or without hyperlipidaemia. Patients with two consecutive elevated blood pressure (BP) readings (>140/80 mmHg) were recruited via referral from out-patient clinics and diabetic nurse specialists. A range of clinical indicators were assessed on referral. The pharmacist prepared individualised patient information and a patient-held record card. An evidence-based algorithm was used to make adjustments (every 4 weeks) to anti-hypertensive medication. If necessary treatment of hyperlipidaemia was also optimised. Published data was used to predict the 10-year risk of coronary heart disease and cerebrovascular accident for each patient before and after intensive medicines management. Patients were discharged from the clinic after two consecutive target BP measurements.
It is estimated that these risks were reduced by 11.9 and 9.6%, respectively, at a cost per event avoided of £34,708 and £63,320.
Intensive pharmacist-led clinics are potentially a cost-effective way to improve the cardiovascular health of patients with type␣2 diabetes.
KeywordsDiabetes mellitus Hypertension Hyperlipidaemia Pharmacy Cost-effectiveness Cardiovascular risk United Kingdom Pharmacoeconomics Pharmacist
Unable to display preview. Download preview PDF.
We would like to thank the following members of staff at Harrogate Healthcare NHS Trust for their help and support: Dr. Mike Toop, Consultant Chemical Pathologist, The Diabetic Specialist Nursing Team, Angela Wardman, Senior Pharmacist, Medicines Information, Pam Calvert, Director of Pharmacy, Dr. Sean Brotheridge, Consultant Physician, Dr. Hugh Larkin, Consultant Physician.
- 3.Diabetes NSF Team. National service framework for diabetes: standards. London:Department of Health;2001Google Scholar
- 4.Yki-Jarvinen H. Management of type 2 diabetes mellitus and cardiovascular risk: lessons from intervention trials. Drugs 2000;60:975–983Google Scholar
- 6.National Institute for Clinical Excellence (2002). Management of type 2 diabetes: management of blood pressure and blood lipids (Guideline H). London: NICE;2002 (ISBN 1-84257-251-2)Google Scholar
- 7.Audit Commission. A spoonful of sugar – medicines management in NHS hospitals. London: Audit Commission Publications;2001 (ISBN 1-86240-321-X)Google Scholar
- 8.Crown J. Review of prescribing, supply and administration of medicines. London:NHS Executive; 1998Google Scholar
- 9.Secretary of State for Health. Health & Social Care Act 2001. London: Stationary Office;2001 [Chapter 15]. Google Scholar
- 10.National Health Service (Pharmaceutical Services) (General Medical Services) and (Charges for Drugs and Appliances). Amendment Regulations 2003. London: The Stationary Office;2003 [Statutory Instruments 2003 No. 1084]Google Scholar
- 13.Goldberg R, Mellies MJ, Sacks FM, Moyé LA, Howard BV, Howard WJ et al. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analysis in the cholesterol and recurrent events (CARE) trial. Circulation 1998;98:2513–2519PubMedGoogle Scholar
- 15.Olsson AG, Eriksson M, Johnson O, Kjellstrom T, Lanke J, Larsen ML et al. A 52-week, multicenter, randomized, parallel-group, double-blind, double-dummy study to assess the efficacy of atorvastatin and simvastatin in reaching low-density lipoprotein cholesterol and triglyceride targets: the treat-to-target (3T) study. Clin Ther 2003;25:119–138PubMedCrossRefGoogle Scholar
- 16.British National Formulary No 43 (March 2002) (Published by British Medical Association & Royal Pharmaceutical Society of Great Britain) ISBN 0521770297Google Scholar
- 18.UKPDS Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998;317:703–713Google Scholar
- 20.Secretary of State for Health. The NHS plan: a plan for investment, a plan for reform. London; Department of Health; 2000 (Cm 4818-I)Google Scholar