Economic Evaluations of Clinical Pharmacy Services: 2006–2010
Authors: Touchette Daniel R. , Doloresco Fred , Suda Katie J. , Perez Alexandra , Turner Stuart , Jalundhwala Yash , Tangonan Maria C. , Hoffman James M. 
Published: March 2014

Studies have consistently evidenced the positive clinical, economic, and humanistic benefits of pharmacist‐directed patient care in a variety of settings. Given the vast differences in clinical outcomes associated with evaluated clinical pharmacy services (CPS), more detail as to the nature of theCPSis needed to better understand observed differences in economic outcomes. With the growing trend of outpatient pharmacy services, these economic evaluations serve as viable decision‐making tools in choosing the most effective and cost‐effective pharmacy programs. We previously conducted three systematic reviews to evaluate the economic impact ofCPSfrom 1988 to 2005. In this systematic review, our objectives were to describe and evaluate the quality of economic evaluations ofCPSpublished between 2006 and 2010, with the goal of informing administrators and practitioners as to their cost‐effectiveness. We searched the scientific literature by using theMedline, International Pharmaceutical Abstracts,Embase, and Cumulative Index to Nursing and Allied Health Literature databases to identify studies describingCPSpublished from 2006 to 2010. Studies meeting our inclusion criteria (original research articles that evaluatedCPSand described economic and clinical outcomes) were reviewed by two investigators. Methodology used, economic evaluation type,CPSsetting and type, and clinical and economic outcome results were extracted. Results were informally compared with previous systematic reviews. Of 3587 potential studies identified, 25 met inclusion criteria. CommonCPSsettings were hospital (36%), community (32%), and clinic or hospital‐based ambulatory practices (28%).CPStypes were disease state management (48%), general pharmacotherapeutic monitoring (24%), target drug programs (8%), and patient education (4%). Two studies (8%) listedCPSas medication therapy management. Costs were evaluated in 24 studies (96%) and sufficiently described in 13 (52%). Clinical or humanistic outcomes were evaluated in 20 studies (80%) and were sufficiently described in 18 (72%). Control groups were included in 16 (70%) of 23 studies not involving modeling. Study assumptions and limitations were stated and justified in eight studies (32%). Conclusions and recommendations were considered justified and based on results in 24 studies (96%). Eighteen studies (72%) involved full economic evaluation. The mean ± SDstudy quality score for full economic evaluations (18 studies) was 60.4 ± 22.3 of a possible 100 points. Benefit‐cost ratios from three studies ranged from 1.05:1 to 25.95:1, and incremental cost‐effectiveness ratios of five studies were calculated and reported. Fewer studies documented the economic impact ofCPSfrom 2006–2010 than from 2001–2005, although a higher proportion involved controlled designs and were full economic evaluations. Evaluations of ambulatory practices were increasingly common.CPSwere generally considered cost‐effective or provided a good benefit‐cost ratio.