Table 9, Economic evidence profile: Pharmacist support at admission versus no ward-based pharmacist - Emergency and acute medical care in over 16s: service delivery and organisation

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Study	Applicability	Limitations	Other comments	Incremental cost	Incremental effects	Cost effectiveness	Uncertainty
Fertleman 2005¹⁹ [UK]	Partially applicable^a	Potentially serious limitations^b	Before-and-after observational study Population: medical patients admitted within the preceding 24 hours to a general medical ward at a district general hospital (Northwick Park hospital in north-west London) Comparators: Ward-based pharmacist provide pharmaceutical care for 1-2 hours at some time during the day (usual care) Senior pharmacist present on post-admission (post-take) ward rounds (PTWR) in addition to the usual care Follow-up: 3 days	2 versus 1: Saves £142 in the increase in drug costs between admission and discharge	2 versus 1: n/a	Pharmacist presence during ward round cost saving	None reported.

Study

Applicability

Limitations

Other comments

Incremental cost

Incremental effects

Cost effectiveness

Uncertainty

Fertleman 2005¹⁹

[UK]

Partially applicable^a

Potentially serious limitations^b

Before-and-after observational study
Population: medical patients admitted within the preceding 24 hours to a general medical ward at a district general hospital (Northwick Park hospital in north-west London)
Comparators:
- Ward-based pharmacist provide pharmaceutical care for 1-2 hours at some time during the day (usual care)
- Senior pharmacist present on post-admission (post-take) ward rounds (PTWR) in addition to the usual care
Follow-up: 3 days

2 versus 1:

Saves £142 in the increase in drug costs between admission and discharge

2 versus 1:

n/a

Pharmacist presence during ward round cost saving

None reported.

: Abbreviations: ICER: incremental cost-effectiveness ratio; ICU: intensive care unit; n/a: not applicable; pADE: preventable adverse events; QALY: quality-adjusted life years; RCT: randomised controlled trial; SD: standard deviation.
(a): QALYs were not used as an outcome measure. Some uncertainty regarding the applicability of resource use and costs from 2003 to current NHS context.
(b): Observational study with no adjustment for confounders, so by definition not reflecting all evidence in this area. The study has a very short follow-up time for both the pre- and post-intervention phases (3 ward rounds each) and the calculated cost-saving was extrapolated over a year. Long-term impact on costs and outcomes has not been assessed. Additionally, limited costs were included in the analysis (medication costs and pharmacist time). No sensitivity analysis is reported.

Emergency and acute medical care in over 16s: service delivery and organisation.

NICE Guideline, No. 94.

National Guideline Centre (UK).

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