Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial

  • Neilson A
  • Bruhn H
  • Bond C
 et al. 
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Abstract

OBJECTIVES: To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT. DESIGN: Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI). SETTING: Six general practices: Grampian (3); East Anglia (3). PARTICIPANTS: 125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months. INTERVENTIONS: Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU). MAIN OUTCOME MEASURES: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation. RESULTS: Unadjusted total mean costs per patient were 452 for prescribing (SD: 466), 570 for review (SD: 527) and 668 for TAU (SD: 1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were 77 for prescribing (95% CI -82 to 237) and 54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of 30,000 and 20,000 per QALY gained, respectively. CONCLUSIONS: Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups. TRIAL REGISTRATION NUMBER: ISRCTN06131530.Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Authors

  • A. R. Neilson

  • H. Bruhn

  • C. M. Bond

  • A. M. Elliott

  • B. H. Smith

  • P. C. Hannaford

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