The cost-effectiveness of pharmacist-led treatment of cardiac risk in patients with type 2 diabetes

People with type 2 diabetes mellitus have an increased risk of cardiovascular and cerebrovascular disease compared with the general population. Following attempts to change lifestyle, pharmacological treatment is necessary to modify this risk. However, the use of medicines may be sub-optimal because of infrequent or inadequate medication review. Harrogate District Hospital, a medium-sized district general hospital in a rural area of North Yorkshire, England. A pharmacist-led hospital clinic was established to manage diabetic patients suffering from resistant hypertension with or without hyperlipidaemia. Patients with two consecutive elevated blood pressure (BP) readings (> 140/80 mmHg) were recruited via referral from out-patient clinics and diabetic nurse specialists. A range of clinical indicators were assessed on referral. The pharmacist prepared individualised patient information and a patient-held record card. An evidence-based algorithm was used to make adjustments (every 4 weeks) to anti-hypertensive medication. If necessary treatment of hyperlipidaemia was also optimised. Published data was used to predict the 10-year risk of coronary heart disease and cerebrovascular accident for each patient before and after intensive medicines management. Patients were discharged from the clinic after two consecutive target BP measurements. It is estimated that these risks were reduced by 11.9 and 9.6%, respectively, at a cost per event avoided of 34,708 pound and 63,320 pound. Intensive pharmacist-led clinics are potentially a cost-effective way to improve the cardiovascular health of patients with type 2 diabetes.