Abstract
The aim of this study is to evaluate the impact of adopting a pharmaceutical care model on clinical outcomes, patient satisfaction, and cost at a health payer level.
All patients with hepatitis C virus (HCV) who were insured by Bupa Arabia, with a direct-acting antivirals prior authorization drug request between April 2015 and October 2018 were included in this retrospective quasi-experimental study. The clinical outcome was the achievement of a sustained virologic response at least 12 weeks from end of treatment. Economic and patients’ satisfaction outcomes were included in this study. The differences in cost of treatment was analyzed by using the paired t test. Stata statistical software package (StataCorp, College Station, TX) was used for data analysis.
A total of 371 patients were enrolled in this program of which 74% (n = 273) required clinical intervention. Among those, HCV treatment was modified for 64%. The overall cure rate was 97% among 267 patients for which sustained virologic responses were available. The results of the paired t test show that there was a 38% reduction in the mean direct cost of medications before and after intervention (95% confidence interval, 33%-43%; P<.001) and the calculated patients’ satisfaction was 98%.
A structured pharmaceutical care program for HCV patients can guide the use of specialty medications to achieve optimal clinical outcomes, with lower expenditures and high patients’ satisfaction. We can conclude that healthcare insurance can play a key role in managing specialty pharmaceuticals like HCV medications. Because this is a preliminary study, further studies are needed in an experimental design to strengthen the evidence behind the effectiveness of such a program.
•This is the first-ever health insurance level report in a developing country that assessed the economic cost and clinical value of the pharmaceutical care program for chronic patients. Researches describing the impact of the pharmaceutical care are limited to the hospital and community pharmacies. Yet, this study is very important because it displays and builds the concept in view of different field, which is the health insurance system.•This study presents and displays that a new pharmaceutical care program for hepatitis C medications is necessary to achieve the best outcomes. In addition, it bridges the gap and shows the relation between several pharmaceutical concepts (pharmaceutical care model, and pharmaceutical specialties) with a new application at health insurance system. Moreover, it advocates a new role of the clinical pharmacist at health payer that is not available nowadays, at least in the Middle East.•This study specifically designed to highlight the importance of the pharmaceutical care program and its impact on the cost and promote an understanding on the possibilities of implementing such model that could be affecting a part of our community and to provide ways of dealing with it. It does as well to support the policy makers in the coverage of certain type of medications by health insurance system.