Economic evaluation of pharmacists prescribing for minor ailments in Ontario, Canada: a cost-minimization analysis

Abstract

Objectives: The objective of this study was to use a decision-analytic model to examine the potential economic impact of establishing a remunerated programme for pharmacists prescribing for minor ailments (PPMA) in Ontario, Canada.

Methods: A novel decision tool was developed to assess the economic impact of pharmacists prescribing for upper respiratory tract infections (URTIs), contact dermatitis (CD) and conjunctivitis by performing a cost-minimization analysis from a public payer perspective. Two prescribing strategies were compared: (1) PPMA, where patients may seek care from pharmacists or physicians, and (2) the usual care model (UCM), where all patients receive care from physicians. Two remuneration models for the PPMA strategy were also compared: (1) a prescription-detached scenario (PDS), where pharmacists were remunerated CAD$18.00 for each consultation, and (2) a Prescription-Attached Scenario (PAS), where pharmacists were only remunerated if a decision to prescribe was made.

Key findings: At a service uptake rate of 38% for the PDS, the PPMA model led to savings of $7.51, $4.08 and $5.15 per patient for URTIs, CD and conjunctivitis, respectively. Per 30 000 patients, the PPMA model for these minor ailments was projected to lead to cumulative reductions in visits to the emergency department, family physician and walk-in clinics by 799, 3677 and 5090, respectively.

Conclusions: The results of the study strongly suggest that enabling community pharmacists to assess and prescribe for minor ailments could potentially lead to large savings for the government in Ontario, Canada. In 100% of the PAS scenarios simulated, pharmacists as prescribers led to cost savings.

Keywords: economic evaluation; expanded scope; minor ailment; pharmacist; prescribing.

Figure 1

Patient progression through the PPMA and the UCM models. Patients could choose to seek care from either the PPMA model or the UCM. In the PPMA model, patients are assessed by either a pharmacist or a physician (walk-in, ED or family physician). The prescriber has the option of recommending a prescription product, over the counter (OTC) product or not recommend anything. If the ailment does not resolve following the first round of treatment, the patient returns for a second round of assessment, either from a pharmacist or a physician. Alternatively, in the UCM, patients are assessed only by a physician (walk-in, ED or family physician). All patients were assumed to recover after one or two rounds of treatment. Abbreviations: PPMA, pharmacists prescribing for minor ailment; UCM, usual care model; RPh, registered pharmacist; FMD, family physician; ED, emergency department; URTI, upper respiratory tract infection; CD, contact dermatitis.