Economic evaluation of a designated oncology pharmacist in hemato-oncology outpatient care: A randomized clinical trial.

Abstract

11063 Background: Adverse drug reactions (ADRs) and medication errors are major contributors to morbidity and healthcare utilization in hemato-oncology. In a randomized clinical trial, we previously demonstrated that integrating a designated oncology pharmacist significantly reduced ADRs and intercepted potentially serious medication errors. The economic value of this intervention has not yet been established. Methods: We conducted a trial-based cost-effectiveness analysis alongside a single-center randomized clinical trial (n=182), in which adult patients with hematologic malignancies were randomized 1:1 to comprehensive pharmaceutical care delivered by a designated oncology pharmacist versus standard care. Patients were followed for 5 months (4-month intervention plus 1-month follow-up). The primary economic outcome was incremental cost per ADR avoided; secondary outcomes included cost per emergency department visit and hospitalization avoided. The analysis was conducted from the public healthcare system perspective and included only the pharmacist program cost, estimated at $105 per patient over the 5-month study period. Incremental cost-effectiveness ratios (ICERs) were calculated using absolute risk reduction, with uncertainty assessed by nonparametric bootstrap resampling (5,000 replications). Costs are reported in 2022 USD. Results: ADRs occurred in 47.3% of control patients compared with 23.1% of intervention patients, corresponding to an absolute risk reduction of 24.2% and a number needed to treat of 4.1. The ICER was $434 per ADR avoided (bootstrap 95% CI: $281–$956), with a >99.9% probability that the intervention reduced ADRs. Secondary outcomes also favored the intervention: emergency department visits (37.4% vs 28.6%; ICER $1,194 per visit avoided) and hospitalizations (28.6% vs 23.1%; ICER $1,911 per hospitalization avoided). In addition, the pharmacist intercepted 287 medication errors in real time, including 13 potentially severe errors, with a physician acceptance rate of 94.8%. Conclusions: This economic evaluation demonstrates that integrating a designated oncology pharmacist in hemato-oncology outpatient care is a cost-effective strategy for preventing ADRs and reducing acute healthcare utilization. These findings support broader implementation of oncology pharmacists as a high-value patient safety intervention.