Introduction The fact that one quarter of the population of Europe is now of pensionable age,¹ has implications for the allocation of health care resources. It has been recommended that, in addition to examining outcome measures such as quality of life and reduction in drug related problems, the economic impact of pharmaceutical care interventions should also be evaluated.² This study examines the economic impact of a community pharmacy based pharmaceutical care programme for elderly patients.

Method An economic model using SPSS for Windows (version 7) was developed to examine the incremental costs and effects associated with the provision of a community pharmacy based pharmaceutical care programme to elderly patients. The evaluation was performed from the perspective of the payer and based on information gathered from a randomised, controlled, longitudinal, clinical trial with repeated measures, carried out over an 18-month period in Northern Ireland, as part of a wider European study.³ A self-completed questionnaire was designed to collect data on costs. The study was performed for three assessment periods, and hence costs were updated accordingly to reflect current market values.
The SF-36 health status questionnaire was used to measure changes in health-related quality-of-life. However, this outcome measure did not adequately capture changes for this patient group, and consequently a cost description analysis was performed. Several categories of costs were determined for both intervention and control patients: cost of hospitalisations; drugs; and the cost associated with time input from general medical practitioners (GPs), nurses and hospital based consultants, and additional time input associated with pharmacists providing pharmaceutical care to the intervention group. Key parameters of the model were subjected to sensitivity analysis.

Focal points

The rising number of elderly persons in the population has implications for the allocation of limited health care resources

• An economic evaluation was carried out to determine the costs and effects associated with the provision of a community pharmacy based pharmaceutical care programme to elderly patients
• Components of the total cost of providing this programme, such as, costs of hospitalisations, drugs, contacts with pharmacists, GPs, nurses and consultants were examined
• The average cost per patient in the intervention group (for all three assessment periods) was significantly lower than for patients in the control group
• The cost of funding such a programme could be offset against expected cost savings generated by implementing the programme

Results and discussion The average cost per patient associated with pharmacist input for the three assessment periods was £23.62, £10.24 and £9.67, respectively.
The pharmacist's time input per patient was largest in the first assessment period because of the greater level of intervention required. The largest cost component for both intervention and control groups was associated with hospitalisations and drugs; cost input due to health care professionals was minimal. Between-group comparisons for each of the other cost components indicated that within the first assessment period there were reduced costs associated with hospitalisations and drugs, despite increased contacts (and hence cost) with GPs and nurses (Mann Whitney test P<0.05).
In the second assessment period (6-12 months), a similar pattern emerged with the intervention group exhibiting an increase in contacts (this time with their consultant) being offset by reduced hospitalisation costs and drug costs (P<0.05).
In the final assessment period, intervention patients had significantly lower costs associated with contacts with GPs but higher costs associated with contacts with consultants (P<0.05).
Implementation of the programme achieved a cost saving of £304.84 per patient in the first assessment period, followed by £91.69 and £10.51 respectively in the second and third assessment periods (Figure 1).

Figure 1: Comparison of average cost per patient for each six-month assessment period