Economic evaluation and clinical impact of home medication review (HMR) by community pharmacists among patients with type 2 diabetes mellitus (T2DM) / Mohd Rozaini Rosli

Objective: Successful diabetes treatment requires commitment and understanding of disease management by the patients. This trial aimed to evaluate the clinical and economic impacts of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and as a cost-effective intervention from the Malaysian healthcare provider perspective. Methodology: A randomised controlled trial (RCT) was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The economic evaluation was conducted alongside the RCT to estimate the intermediate cost-effectiveness of HMR-CP for patients with T2DM. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) and quality-adjusted life-years (QALYs), while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. The utility value measured using five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L). For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The costs included in the studies was cost of implementing the intervention and the cost associated with the use of healthcare services. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively. A Markov model was then constructed to project the lifetime cost-effectiveness data beyond the RCT. The primary outcomes for the economic evaluation were cost per HbA1c reduction and cost per quality-adjusted life-years (QALYs).