Clinical and Economic Outcomes of Virtual vs. In-Person Transplant Pharmacotherapy Clinics: A Cross-Sectional Study in Iran

Background Pharmacist-led pharmacotherapy clinics play an essential role in optimizing medication use and preventing adverse drug events (ADEs) among solid organ transplant (SOT) recipients. Evidence comparing the clinical and economic value of virtual versus in-person transplant pharmacotherapy clinics remains limited, particularly in resource-constrained settings. Methods This cross-sectional study evaluated SOT candidates and recipients who received pharmacist-led virtual consultations (October–December 2024) or in-person consultations (September 2024–May 2025) at a tertiary transplant center in Iran. Pharmacist interventions included medication reconciliation, identification and resolution of drug-related problems (DRPs), adherence monitoring, and vaccination review. ADE risk was estimated using a validated risk-matrix approach, and a partial cost–benefit analysis was conducted from a societal perspective, incorporating direct medical and nonmedical costs. Cost savings from medication optimization and cost avoidance from estimated preventable ADEs were calculated, and benefit-to-cost ratios (BCRs) were derived. Results A total of 232 patients (63.1% male; mean age 50.3 ± 12.4 years) were evaluated. Pharmacists identified 1,607 DRPs and issued 2,268 recommendations, with preventive therapy needs being the most common DRP category. An expert panel estimated 428 preventable ADEs across both clinic models. The virtual clinic generated direct cost savings of $1,882.93 and cost avoidance of $30,552.43, while the in-person clinic achieved $768.07 in direct savings and $75,666.94 in cost avoidance. The resulting BCRs were 11.1:1 for the virtual clinic and 12.3:1 for the in-person clinic. Conclusions Pharmacist-led virtual and in-person transplant pharmacotherapy clinics were associated with improved medication safety and substantial economic benefits. These findings support the integration of Telepharmacy services into transplant care, particularly in low- and middle-income healthcare systems.