Cost-Benefit Analysis of Appointment-Based Medication Synchronization in the Community Pharmacy

Qaashif Panjwani, Mercer University College of Pharmacy

The U.S. healthcare system incurred a cost of approximately $2.7 trillion in 2010, which accounted for nearly 17.9% of the gross domestic product. Of the total healthcare expenditure, nearly 30% has been identified as wasteful expense such as hospitalization due to medication non-adherence. Non-adherence to medications is suggested to lead to billions of dollars in avoidable direct medical costs. [1]

Cost-Benefit of Appointment-Based Medication Synchronization in the Community Pharmacy [2]
Design Modeling study
Objective To evaluate the cost-benefit of appointment-based medication synchronization (ABMS) offered in community pharmacies
Model Groups Patients enrolled in ABMS vs. standard community pharmacy
Methods The patients included in the model received two refills or more in the past six months for at least one of the following medications: angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin-receptor blockers (ARBs), beta-blockers (BBs), dihydropyridine calcium channel blockers (DCCBs), thiazide diuretics, metformin, and statins. The patients who were in the ABMS program were matched based on prior adherence, medication class, age, gender, and geographic region. The benefit-cost ratio that was determined was the total disease-specific direct medical cost saved due to improved medication adherence associated with ABMS/ total medication cost added due to improved medication adherence associated with ABMS. The proportion of days covered (PDC) was utilized to assess adherence to medications. The PDC was stratified into 5 strata including: (1% – 20%), (21% – 40%), (41% – 60%), (61% – 80%), and (81% – 100%). The medical costs were determined by assigning the specific medications to a particular disease state where the ACE-Is, ARBs, thiazide diuretics, and BBs were assigned to hypertension, metformin was assigned to diabetes, and statins were assigned to hyperlipidemia.
Duration 1-year time horizon
Primary Outcome Measure Benefit-cost ratios for ABMS from the payer perspective
Input and Sensitivity analysis
Model Parameter Base-case Sensitivity analysis
Cost associated with ABMS Medication cost average wholesale price (AWP) – 70% VA drug pricing; AWP; AWP – 50%; AWP – 30%
No patient copay Patient copay of $5 or $10
Reimbursement for ABMS services Annual reimbursement per patient of: $100, $150, $200
Effectiveness of ABMS Increase in percent adherence: 18.4% to 34.7% Adherence varied ± 20%
Odds of adherence with ABMS compared to standard: 2.3 to 3.6 Adherence varied ± 20%
Medical cost by adherence level Average per-patient annual medical saving associated with adherence: $655 to $3019 Adherence varied ± 20%
Results
Medication class Pharmacy practice Drug cost ($) Medical cost ($) Savings per dollar spent on drugs ($)
Metformin Control 185.78 10,747.22
ABMS 231.21 9,068.29 36.96
Thiazide diuretics Control 104.61 9,203.51
ABMS 133.58 9167.22 1.25
Statins Control 395.20 7482.76
ABMS 479.63 6573.25 10.77
ACE-I and ARBs Control 128.59 9067.49
ABMS 141.09 9045.94 1.72
Beta-blockers Control 173.22 9226.99
ABMS 206.37 9109.96 3.53
DCCBs Control 159.27 9228.05
ABMS 195.98 9113.21 3.13
Study Author Conclusions This is the first study to evaluate the cost-benefit of ABMS in community pharmacies. The results indicated that ABMS offers payers a positive return on investment. Although further research is needed to evaluate the long-term costs and outcomes of ABMS, payer partnerships with pharmacies offering ABMS may improve patient outcomes in a cost-beneficial manner.

This study pioneered the value determination of ABMS within the community setting. Limitations include over-simplification of the cost inputs for direct medical costs associated with non-adherence per medication. The direct medical costs associated with non-adherence came from a single observational trial. The observational trial did not take in to account prior adherence levels which potentially overestimates the correlation between medication adherence and lower healthcare costs. Lastly, the study was conducted only for over a 1-year time horizon, which is not long enough as patients can endure many complications decades down the line thereby further increasing direct medical costs. Along with future complications, adherence levels tend to change when comparing patients’ adherence the first year versus twenty years later.

  1. Iuga AO, Mcguire MJ. Adherence and health care costs. Risk Manag Healthc Policy. 2014;7:35-44.
  2. Holdford D, Saxena K. Impact of Appointment-Based Medication Synchronization on Existing Users of Chronic Medications. J Manag Care Spec Pharm. 2015;21(8):662-9.
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