Cost-effectiveness analysis of the community pharmacist-based intervention in Type 2 diabetes mellitus a service trial

Background Studies have shown that managing type 2 diabetes mellitus by community pharmacists improves clinical outcomes such as hemoglobin A1c, controls blood pressure and total cholesterol, and reduces the risk of cardiovascular disease. Objective Since there are no well-designed randomized service trials to assess the impact of community pharmacist intervention on the improvement of T2DM management in Iran, we aimed to (a) determine the long-term effects, (b) evaluate the cost-effectiveness of care provided to T2DM patients, and (c) help policymakers to value these services. Methods In a 12-month trial at a community pharmacy, 55 patients received usual care, while another 55 received a diabetes management protocol from the pharmacist. The pharmacist focused on correcting medication use, lifestyle modification, and improving diet. The technical aspects of economic evaluation contained conducting the study from the healthcare system perspective, a 10-year time horizon was chosen to assess the long-term effects and cost savings. Direct medical costs included the costs of medications, lab tests, and physician visits. Intervention costs covered pharmacist time, patient education materials, and glucose monitoring supplies. The primary outcome was the change in HbA1c levels. Secondary outcomes included life years gained (LYG) and the reduction in the 10-year risk of cardiovascular events. Results Pharmacist's interventions significantly reduced average HbA1c levels and lowered risks for CVD and stroke in the intervention group compared to the control group (p value = 0.009). Cost-effectiveness analysis showed that this intervention resulted in a cost reduction and life years gained over a 10-year time horizon. The PSA analysis showed that pharmacist interventions led to more LYGs and lower costs for the intervention group compared to the control group. The cost-effectiveness plane for 1,000 individuals showed 95.2% of ICER points in the southeast quadrant, indicating the intervention's dominance. Conclusion Involving community pharmacists in diabetic programs can reduce short-term and long-term complications. It emphasizes that providing primary diabetes care by pharmacists benefits patients and brings significant cost savings to the healthcare system.