Cost-minimization analysis of community pharmacy-based point-of-care testing for strep throat in 5 Canadian provinces
Cost-minimization analysis of community pharmacy-based point-of-care testing for strep throat in 5 Canadian provinces
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DOI：
10.1177/1715163518790993
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发表时间：
2018-09-01
影响因子：
1.5
通讯作者：
Agro, Karen
中科院分区：
文献类型：
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作者：
Lathia, Nina;Sullivan, Karen;Agro, Karen
背景：社区药房的链球菌性咽喉炎即时护理 (POC) 测试将使药剂师能够针对这种情况提供护理。我们的目标是在加拿大 5 个省份的药房提供治疗严重喉咙痛的服务时，对治疗严重喉咙痛的服务进行经济评估。方法：我们从公共付款人的角度，对阿尔伯塔省、不列颠哥伦比亚省、新斯科舍省、安大略省和萨斯喀彻温省进行了 5 次单独的成本最小化分析，以估计 2 种情况下每名患者治疗严重喉咙痛的平均成本：1) 在家庭医生办公室、步入式诊所或急诊室进行的基于医生的常规护理(ER) 和 2) 患者接受上述护理或在提供链球菌性咽喉炎 POC 检测的药房中接受护理的新场景。进行单向敏感性分析以解释模型的不确定性。 结果：5 个省的基本案例分析中，每条途径的每位患者的平均成本范围为 1) 家庭医生 37.55 美元至 61.57 美元，2) 预约诊所 37.55 美元至 61.57 美元，3) 急诊室 38.88 美元至 57.56 美元，4) 急诊室 19.12 美元至 21.83 美元。药房，新场景下每位患者可节省 12.47 美元至 24.36 美元。 5 个省份每年节省的总成本约为 130 万至 260 万美元。所有敏感性分析都为新情况节省了成本。讨论：在 5 个省份中，与医生护理相比，在药房进行链球菌性喉炎 POC 检测可以节省成本。敏感性分析证明了这些结果的稳健性。结论：资助这 5 个省的社区药房进行链球菌性喉炎 POC 检测将节省公共卫生系统成本，并可能改善严重咽喉痛患者获得护理的机会。
Background: Strep throat point-of-care (POC) testing in community pharmacies will enable pharmacist-based care for this condition. Our objective was to conduct an economic evaluation of treating severe sore throat when this service was offered in pharmacies in 5 Canadian provinces.Methods: We conducted 5 separate cost-minimization analyses for the provinces of Alberta, British Columbia, Nova Scotia, Ontario and Saskatchewan, from the public payer perspective, to estimate mean cost per patient of treating severe sore throat in 2 scenarios: 1) physician-based usual care in a family physician's office, a walk-in clinic or an emergency room (ER) and 2) a new scenario where patients received care described above or in a pharmacy offering strep throat POC testing. One-way sensitivity analyses were conducted to account for model uncertainty.Results: Mean cost per patient for each pathway in the base-case analyses for the 5 provinces ranged from 1) $37.55 to $61.57 for family physician, 2) $37.55 to $61.57 for walk-in clinic, 3) $38.88 to $57.56 for ER and 4) $19.12 to $21.83 for pharmacy, representing savings ranging from $12.47 to $24.36 per patient for the new scenario. Approximate total cost savings range from $1.3 million to $2.6 million per year across the 5 provinces. All sensitivity analyses yielded cost savings for the new scenario.Discussion: Across 5 provinces, strep throat POC testing in pharmacies was cost saving compared to physician-based care. Sensitivity analyses demonstrated the robustness of these results.Conclusions: Funding strep throat POC testing in community pharmacies in these 5 provinces would lead to public health system cost savings and potentially improve patients' access to care for severe sore throat.