Cost-effectiveness of increasing statin adherence for primary and secondary prevention in community pharmacies

Objectives: Therapy persistence is important to achieve optimal clinical benefits of statin therapy. The aim of this study was to determine the cost-effectiveness of pharmaceutical care in community pharmacies, aimed to increase persistence with statin therapy for both primary and secondary prevention of cardiovascular events (CVEs). Methods: The effectiveness of the Dutch pharmaceutical care program MeMO on improving statin therapy persistence was measured in 500 patients and compared to 502 control patients. Time-investments of the program were also collected. Markov models with lifelong time-horizons were developed to estimate the influence of the program on CVEs: Stroke, myocardial infarction (MI), revascularization and mortality. The efficacy of statins, taken from large clinical trials in primary and secondary prevention, were adjusted for therapy persistence. A Dutch health care provider's perspective was adopted for the analysis and probabilistic sensitivity analyses were performed. Results: Patients in the MeMO program had a lower risk for non-persistence, RR = 0.50 (0.40-0.63), the effect was similar in primary and secondary prevention. In a cohort of 1,000 patients, 60% of whom had a history of CVE, the MeMO program resulted in a reduction of 8 non-fatal strokes 2 fatal strokes, 16 non-fatal MIs, 7 fatal MIs and 14 revascularizations. Additional medication, disease management and intervention costs in the MeMO program were € 375,000; the cost-savings due to reduced CVEs were € 450,000. Thus, the MeMO program resulted in 83 quality-adjusted life-years (QALYs) gained and cost-savings of € 75,000. Clinical benefits and cost-savings were highest in the secondary prevention population. Conclusions: Pharmaceutical care in community pharmacies can improve statin therapy persistence, resulting in more optimal prevention of CVEs. The MeMO program resulted in considerable clinical benefits and overall cost-savings. Persistence and adherence improving programs in community pharmacies may provide good value for money and health care insurers should consider reimbursing these activities in The Netherlands.