Cost-effectiveness of pharmacist-provided treatment of adult pharyngitis.

BACKGROUND There are over 12 million ambulatory care visits for acute pharyngitis annually in the United States. Current guidelines recommend diagnosis through culture or rapid antigen detection test (RADT) and relatively straightforward treatment. Community pharmacists may provide cost-effective care for disease states such as group A streptococcus (GAS) pharyngitis. OBJECTIVES The objective of this research is to evaluate the cost-effectiveness of a community pharmacist-as-provider program for the diagnosis and treatment of pharyngitis caused by GAS as compared with standard of care. METHODS A cost-effectiveness analysis was conducted to compare treatment for adult pharyngitis patients. In addition to 5 physician-provided treatment strategies, the episodic costs and benefits of treatment provided by pharmacists using RADT and walk-in clinics using RADT were also considered. Model parameters were derived through a comprehensive review of literature and from the Centers for Medicare and Medicaid Services physician fee schedule. Utilities were expressed in quality-adjusted life-days (QALDs) to account for the relatively short duration of most cases of pharyngitis. RESULTS Using a cost-effectiveness threshold of $137 per QALD, GAS treatment provided by a pharmacist was the most cost-effective treatment. Pharmacist treatment dominated all of the other methods except physician culture and physician RADT with follow-up culture. The incremental cost-effectiveness ratio (ICER) for physician culture was $6042 per QALD gained and $40,745 for physician RADT with follow-up culture. CONCLUSIONS This model suggests that pharmacists may be able to provide a cost-effective alternative for the treatment of pharyngitis caused by GAS in adult patients.