Economic effects of clinical pharmacy interventions: a literature review.

PURPOSE Economic evaluations of clinical pharmacy interventions are reviewed. SUMMARY A variety of clinical pharmacy interventions have been assessed, but the body of evidence relating to any particular type of intervention is small. Cost-saving interventions comprise a small percentage of clinical pharmacy interventions, but they generated substantial savings. Clinical pharmacists provided added value by participating in multidisciplinary teams attending rounds. Clinical pharmacy interventions reduced preventable adverse drug events and prescribing errors, thereby yielding savings related to cost avoidance. Interventions relating to antibiotic therapy lowered costs of care without adversely affecting clinical outcomes. The results of cost-benefit analyses suggested that general clinical pharmacy interventions are associated with cost savings. Most economic evaluations of clinical pharmacy interventions suffered from a number of methodological limitations relating to the absence of a control group without clinical pharmacy interventions, limited scope of costs and outcomes, focus on direct health care costs only, exclusion of pharmacist employment cost, use of intermediate outcome measures, exclusion of health benefits, and absence of incremental cost analysis. Some avenues for designing future economic evaluations include the use of a control group, detailed descriptions of the interventions provided, evaluations conducted from a societal perspective, consideration of patients' health benefits when assessing economic effect of interventions and hospital costs, and the inclusion of sensitivity and incremental analyses. CONCLUSION Most pharmacoeconomic evaluations of clinical pharmacy interventions demonstrated limitations in their methodological quality and applicability to current practice. Future evaluations should use a comparative study design that includes the incremental cost-effectiveness or cost:benefit ratio of clinical pharmacy interventions from a societal perspective.