Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial

Aileen R Neilson, Hanne Bruhn, Christine M Bond, Alison M Elliott, Blair H Smith, Philip C Hannaford, Richard Holland, Amanda J Lee, Margaret Watson, David Wright, Paul McNamee

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OBJECTIVES: To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT.

DESIGN: Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI).

SETTING: Six general practices: Grampian (3); East Anglia (3).

PARTICIPANTS: 125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months.

INTERVENTIONS: Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU).

MAIN OUTCOME MEASURES: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.

RESULTS: Unadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30,000 and £20,000 per QALY gained, respectively.

CONCLUSIONS: Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups.


Original languageEnglish
Article numbere006874
JournalBMJ Open
Issue number4
Publication statusPublished - 1 Apr 2015


  • Analgesics
  • Chronic Pain
  • Cost-Benefit Analysis
  • Drug Prescriptions
  • Female
  • General Practice
  • Great Britain
  • Health Care Costs
  • Humans
  • Intention to Treat Analysis
  • Male
  • Pain Management
  • Pharmacists
  • Pharmacy
  • Primary Health Care
  • Professional Role
  • Quality-Adjusted Life Years
  • Standard of Care
  • State Medicine
  • Surveys and Questionnaires


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