Hendrie, D., Smith, D., and Couzos, S. (2020) Economic evaluation of the Integrating Pharmacists within Aboriginal Community Controlled Health Services (ACCHSs) to improve Chronic Disease Management (IPAC Project). External Commissioned Report. Australian Government, Canberra, ACT, Australia.

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Abstract

Objective: An economic analysis was conducted as part of the IPAC project to establish its costs and impacts and assess the extent to which it represented value for money.

Methods: The economic evaluation was a within-trial analysis that adopted a perspective of the publicly funded health system. Participants were Aboriginal and Torres Strait Islander patients with chronic disease who were 18 years and above and who were regular patients of the ACCHSs. Three types of economic analysis were conducted: (i) a cost-consequence analysis that included all participants with changes in biomedical indices for whom pre- and post-measures of outcomes were recorded; (ii) a cost-effectiveness analysis for two sub-groups of participants: those with T2DM with pre- and post-measures of HbA1c and those selected for MAI assessments at baseline and at the end of the study, with potential prescribing omissions (PPOs) used as the relevant outcome measure; and (iii) for participants with a clinical diagnosis of T2DM, a cost-utility analysis that derived lifetime quality of life changes from the decreases in HbA1c observed during the trial period based on T2DM simulation models. Costs and outcome data, with the exception of the modelled QALY changes, were obtained directly from the IPAC trial. Costs included value of resources from delivering the intervention as well as changes in health service use in the short term (trial time period compared with pre-intervention period). Cost offsets from savings as a result of integrating pharmacists in usual care were also included.

Results: In the cost-consequence analysis, the net costs of delivering the intervention of $1,493 per person was associated with statistically significant improvements in the following biomedical indices for participants with pre and post-intervention measures: glycated haemoglobin (HbA1c) (for participants with a clinical diagnosis of T2DM), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), cardiovascular risk 5-year risk (CVD 5-year risk) and estimated glomerular filtration rate (eGFR). In the cost-effectiveness analysis, for participants with a clinical diagnosis of T2DM, the ICER of the IPAC intervention versus no intervention was $3,769 per participant with a clinically meaningful reduction in HbA1c of at least 0.5%. In the case of the subset of participants selected for MAI assessments, the corresponding ICER was $6,809 per reduction in the number of participants with a PPO. For participants with a clinical diagnosis of T2DM, the cost-utility analysis yielded an ICER of $7,463 (95% CI $6,030 –$9,664) per gain in quality adjusted life years (QALYs), assuming no lifetime costs additional to usual care were required to maintain the reduction in HbA1c. Financial implications of implementing the IPAC intervention more widely within ACCHSs were also calculated. On an annual basis, the extended IPAC intervention was estimated to cost $13.2 million. The corresponding annual increase in utilisation of medications and primary health care services associated with better medication management support was $5.1 million. However, cost savings were also likely to be achieved from the improvement in health outcomes, for example, from a reduction in the utilisation and corresponding costs of emergency department presentations and hospital admissions. Under different scenarios, these cost savings were assessed as falling between $0.6 and $1.9 million per annum, varying according to the expected decrease in utilisation achieved.

Conclusion: The IPAC intervention found relatively low costs to be associated with increases in the utilisation of medications and primary health care services, the latter having the potential to contribute to more equitable, needs-based health care expenditure for the Aboriginal and Torres Strait Islander population. Additionally, the modelled cost-utility analysis conducted for patients with T2DM found that, based on commonly used reference ICERs for the Australian health system, the ICER of $7,463 represented good value for money.

Item ID:	87561
Item Type:	Report (External Commissioned Report)
Keywords:	economic analysis, Aboriginal, Torres Strait Islander, Integrated care, Pharmacy, Pharmacists, primary health care, chronic disease, diabetes, medication adherence
Additional Information:	This report is publicly available at the following website: https://www.health.gov.au/resources/publications/integrating-practice-pharmacists-into-aboriginal-community-controlled-health-services-final-report
Funders:	Australian Government Department of Health & Ageing
Projects and Grants:	Pharmacy Trials Program
Date Deposited:	03 Oct 2025 04:49
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 50% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3214 Pharmacology and pharmaceutical sciences > 321403 Clinical pharmacy and pharmacy practice @ 50%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200102 Efficacy of medications @ 50% 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
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