Cost-effectiveness analysis of a community pharmacist-based intervention to prevent cardiovascular complications in patients with type 2 diabetes in Iran.

Background: Evidence suggests that community pharmacist-led interventions in managing type 2 diabetes mellitus (T2DM) can improve clinical outcomes such as glycated hemoglobin (HbA1c), blood pressure, and lipid profiles, thereby reducing the risk of cardiovascular complications. However, limited research has evaluated the economic value of such interventions, particularly in the context of Iran.

Objective: Given the absence of well-designed studies assessing the cost-effectiveness of community pharmacist-based interventions in preventing cardiovascular complications among patients with T2DM in Iran, this study aimed to evaluate the economic and clinical impact of such an intervention. Standard care provided by community pharmacists served as the comparator.

Methods: This study was conducted over 12 months in a community pharmacy setting. A total of 110 patients with T2DM were enrolled, with 55 receiving usual care (comparator group) and 55 receiving a structured pharmacist-led intervention. The intervention included medication optimization, lifestyle counseling, and dietary guidance, with a focus on reducing cardiovascular risk. Economic evaluation was performed from the healthcare system perspective using a Markov model over a 10-year time horizon. Outcomes included life years gained (LYG) and reduction in the 10-year risk of cardiovascular events. Direct medical costs for both the intervention and comparator groups were considered.

Results: Pharmacist-led interventions significantly reduced average HbA1c levels (p = 0.009), improved HDL cholesterol (p = 0.016), and lowered LDL cholesterol (p = 0.05) in the intervention group compared to the comparator. SBP also showed a statistically significant improvement in the intervention group (p = 0.003), while the comparator group experienced an increase in SBP. The estimated 10-year risks for coronary heart disease (CHD) and stroke, both fatal and nonfatal, were lower in the intervention group. The cost-effectiveness analysis revealed that the intervention resulted in a cost saving of -1469.02 USD and an additional 0.045 life years gained compared to usual care.

Conclusion: The findings suggest that community pharmacist-led interventions targeting cardiovascular risk reduction in patients with T2DM are both clinically effective and cost-efficient. Incorporating pharmacists into diabetes care programs may significantly improve cardiovascular outcomes while reducing long-term healthcare costs in Iran.