Diabetes: Increased Pharmacist Involvement Results in Savings

Diabetes management cost the United States an estimated $245 billion in 2012, including $176 billion for direct treatment and complications.

Traditionally, routine diabetes care is handled by primary care physicians (PCP). Previous studies have shown that patients treated under PCP-pharmacist collaborative practice models exhibit better glycemic control and experience a smaller increase in care costs over time.

New research published in the March 2017 issue of Journal of Specialty Care & Managed Pharmacy suggests that intensifying the practice model could further improve these outcomes. Researchers at the University of California, San Diego compared a Diabetes Intense Medical Management (DIMM) clinic involving endocrinologist-pharmacist collaboration with conventional PCP care to determine the cost-effectiveness and cost-benefits.

The DIMM clinic, set up at the Veteran Affairs San Diego Health Clinic, treated patients with type 2 diabetes over a 6-month period. Treatment consisted of 3-hour-long pharmacist visits and included medication therapy management, laboratory testing, and patient-specific education. The researchers calculated cost effectiveness ratios after 6 months, along with 3-year estimated total medical costs avoided and quality-adjusted life-years (QALYs) over a 10-year period.

This model differs from other models in that it is a short, intense intervention. Pharmacists work closely with patients for a few months, and then discharge them back to their usual care.

The researchers concluded that DIMM patients cost $21 per additional percentage point of HbA_1c improvement. The associated cost avoidance saved $8,793 in medical costs compared to $3,506 for PCP patients. DIMM patients also had lower total costs, gained more QALYs, and had lower long-term risk for diabetes-related complications than the PCP group.

The researchers concluded that more personalized care and increased pharmacist involvement can illicit positive results in patients with diabetes.

The advanced clinical practice model is ideal for complex patients with a high medication burden, the researchers wrote. They added that further research is required to expand the DIMM clinic model to larger, more diverse populations.

Reference

Hirsch JD, Bounthavong M, Arjmand A, et al. Estimated Cost-Effectiveness, Cost Benefit, and Risk Reduction Associated with an Endocrinologist-Pharmacist Diabetes Intense Medical Management "Tune-Up" Clinic. J Manag Care Spec Pharm. 2017;23(3):318-326.