Economic evaluations of clinical pharmacy services

The objectives of this review were to (1) summarize and evaluate studies that measured the economic impact of clinical pharmacy services (CPSs) published between 2001 and 2005 (inclusive) and (2) provide guidance on methodological considerations to individuals performing such research in the future. A systematic literature search using MEDLINE and International Pharmaceutical Abstracts was conducted to identify published economic evaluations of CPSs. Studies were screened and then randomly assigned to reviewers, who reassessed inclusion/exclusion criteria and abstracted prespecified data from each study. Among the many characteristics examined in each study were study design and type of economic evaluation, setting and type of CPS, study quality, and results. Ninety-three articles were included in the final analysis. Included studies were published in 43 different journals, most of which (68 [73.1%]) were pharmacy-based. Most studies were performed in hospitals (40 [43.0%]), ambulatory care clinics or physician’s offices (20 [21.5%]), or community pharmacies (16 [17.2%]). The most common types of CPSs evaluated were general pharmacotherapeutic monitoring services (32 [34.4%]), target drug programs (27 [29%]), and disease state management services (21 [22.6%]). Full economic evaluations were performed in just less than half (45 [48.4%]) of the studies, and a positive economic benefit associated with CPSs was noted in 69 % (n=31) of these. Among studies reporting data necessary to determine a benefit-to-cost ratio (n=15), the pooled median value was 4.81:1—meaning that for every $1 invested in CPS, $4.81 was achieved in reduced costs or other economic benefits. The quality of studies varied widely, with less than one-half considered good to fair (40 [43.0%]), but the proportion of studies using appropriate study designs increased compared with previous reviews. Based on the evidence examined in this review, CPSs continue to provide a significant return on investment, but improvements are still needed in the methods used to evaluate the economic impact of these services