Cost-Effectiveness of Pharmacist Managed Medication Therapy Adherence Clinic (MTAC) on Type 2 Diabetes Patients in a Tertiary Hospital in Malaysia

Purpose:   This study was conducted: 1) To study the impact of pharmacist managed Medication Therapy Adherence Clinic (MTAC) on medication adherence and glycemic control of Type 2 Diabetes patients and 2) To evaluate the cost-effectiveness of MTAC program.

Methods: In this prospective cohort study, 43 Type 2 Diabetes patients who attended pharmacist MTAC clinic visits in Kuala Lumpur Hospital besides their routine physician visits between February 2008 to August 2009 were assigned to Intervention group while 42 others who attended physician visits only (Standard Care) as Control. The Intervention group received medication adherence assessment, advise on drug related problems, medication counseling and diabetes education by pharmacists while the Control group did not. HbA1c levels (%) and Morisky Scores were measured and compared at baseline and after 9 months follow-up period between both groups. Direct medical costs including doctor’s cost, pharmacist’s cost, nurse’s cost, cost of medications and cost of laboratory tests were used for cost-effectiveness analysis (CEA).

Results: Medication adherence of subjects in the Intervention (MTAC) group increased significantly from a Morisky score of 4.23 at baseline to 7.84 (p < 0.05) compared to increase from 4.00 to 6.14 seen in Control at the end of follow-up. The HbA1c of subjects in the Intervention arm also reduced significantly (p < 0.05) by 1.7% from 10.6% at baseline to 8.9% at the end of follow-up compared with a relatively smaller decrease of 0.6% from 10.7% at baseline to 10.1% achieved in Control (p > 0.05). Average cost effectiveness ratio (ACER) for Intervention group was RM446.01 per 1% reduction and RM1328.52 per 1% HbA1c reduction for Control.

Conclusions: Pharmacist managed MTAC Diabetes program helped Type 2 Diabetes patients achieve significantly better medication adherence and glycemic control besides being more cost-effective than Standard Care with greater savings in diabetes expenditure to the hospital.