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

Aileen R Neilson; Hanne Bruhn; Christine M Bond; Alison M Elliott; Blair H Smith; Philip C Hannaford; Richard Holland; Amanda J Lee; Margaret Watson; David Wright; Paul McNamee

doi:10.1136/bmjopen-2014-006874

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

Aileen R Neilson, Hanne Bruhn, Christine M Bond, Alison M Elliott, Blair H Smith, Philip C Hannaford, Richard Holland, Amanda J Lee, Margaret Watson, David Wright, Paul McNamee

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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.

Original language	English
Article number	e006874
Journal	BMJ Open
Volume	5
Issue number	4
DOIs	https://doi.org/10.1136/bmjopen-2014-006874
Publication status	Published - 1 Apr 2015

Bibliographical note

Funding The project was funded by the Medical Research Council (grant ID: 85356). The Health Economics Research Unit is partly funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

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Pharmacist-led management of chronic pain in primary care
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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Christine Bond
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Emeritus Professor
Person: Honorary
Amanda Lee
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Medical Statistics
- Institute of Applied Health Sciences
- School of Medicine, Medical Sciences & Nutrition, Medical Statistics
Person: Academic
Paul McNamee
- School of Medicine, Medical Sciences & Nutrition, Health Economics Research Unit - Personal Chair
Person: Academic

Cite this

@article{ee4a2bd829e14e78ba26f06729125675,

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

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.",

author = "Neilson, {Aileen R} and Hanne Bruhn and Bond, {Christine M} and Elliott, {Alison M} and Smith, {Blair H} and Hannaford, {Philip C} and Richard Holland and Lee, {Amanda J} and Margaret Watson and David Wright and Paul McNamee",

note = "Funding The project was funded by the Medical Research Council (grant ID: 85356). The Health Economics Research Unit is partly funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.",

year = "2015",

month = apr,

day = "1",

doi = "10.1136/bmjopen-2014-006874",

language = "English",

volume = "5",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "4",

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TY - JOUR

T1 - Pharmacist-led management of chronic pain in primary care

T2 - costs and benefits in a pilot randomised controlled trial

AU - Neilson, Aileen R

AU - Bruhn, Hanne

AU - Bond, Christine M

AU - Elliott, Alison M

AU - Smith, Blair H

AU - Hannaford, Philip C

AU - Holland, Richard

AU - Lee, Amanda J

AU - Watson, Margaret

AU - Wright, David

AU - McNamee, Paul

N1 - Funding The project was funded by the Medical Research Council (grant ID: 85356). The Health Economics Research Unit is partly funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - 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.

AB - 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.

U2 - 10.1136/bmjopen-2014-006874

DO - 10.1136/bmjopen-2014-006874

M3 - Article

SN - 2044-6055

VL - 5

JO - BMJ Open

JF - BMJ Open

IS - 4

M1 - e006874

ER -

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

Abstract

Bibliographical note

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Christine Bond

Amanda Lee

Paul McNamee

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