JULY 2015 - Pharmacists’ care for hypertension management—including independent prescribing authority—can generate significant savings for the Canadian healthcare system, according to a peer-reviewed economic analysis published in the May/June edition of Canadian Pharmacists Journal.
In the research article, entitled Cost-effectiveness of pharmacist care for management hypertension and Canada, full-scope pharmacist care (i.e., including independent prescribing authority) would save approximately $6,400 in costs over the lifetime of a patient. For every five patients there would be one less cardiovascular event (stroke, heart attack, angina or heart failure). Over a 30-year period this translates into $15.7 billion in cost savings (assuming half of Canadians with poorly controlled hypertension take part) and significant reductions in cardiovascular events—for example, there would be 260,000 fewer heart attacks and almost 1 million life-years saved.
“The results are stunning,” says Dr. Ross Tsuyuki, one of the authors of the economic analysis and Professor of Medicine and Director of the EPICORE Centre at the University of Alberta. “As clinicians we can say that reducing the risk of stroke by 40% to 50% is good, and that impresses us, but it doesn’t necessarily impress policy makers. But when we can say that we will get better clinical outcomes and we will save money, then it becomes extraordinarily compelling.”
Tsuyuki hopes this evidence will help convince other provinces to adopt the degree of independent prescribing authority that’s currently possible only in Alberta. “Although pharmacists’ services under a partial scope without independent prescribing would still be considered cost-effective, that’s really missing the point. Partial scope is setting the bar in the wrong place. It does not really allow the profession to move forward.”
The economic analysis drew from two primary clinical studies: the 2015 Alberta Clinical Trial in Optimizing Hypertension (RxACTION), funded in part by CFP’s Innovation Fund, in which pharmacists with independent prescribing authority helped patients achieve an average reduction of 18.3 mmHg in systolic blood pressure; and a meta-analysis of 39 randomized controlled trials of pharmacists’ interventions, excluding independent prescribing, which saw an average reduction of 7.6 mmHg in systolic blood pressure. As part of its determination of costs, it used the pharmacy services fee schedule currently used by Alberta’s drug plan ($125 for an initial annual consultation and $25 for follow-ups).
At the Canadian Pharmacists Association’s annual conference in May, Tsuyuki and Dr. Nadia Khan, Professor of Medicine and University of B.C. and general internist, St. Paul’s Hospital, co-presented results of the economic analysis. Khan is also the current President of Hypertension Canada, which produces the Hypertension Canada (formerly CHEP) guidelines for hypertension management.
Both Tsuyuki and Khan are available to meet with pharmacy associations and regulators, governments and physician bodies to explain the results and make the case for pharmacists’ expanded role in hypertension management, says Tsuyuki. As well, Hypertension Canada is developing a hypertension certification program for pharmacists, which should be available early in 2018, and policies to promote shared care with pharmacists.