A systematic review of economic evaluations of clinical pharmacy Services in the United States: 2018–2022

Evaluating the economic impact of clinical pharmacy services (CPS) is important for program implementation and sustainability. This study systematically reviewed economic evaluations of United States-based CPS published between 2018 and 2022. A systematic search was conducted across PubMed, EMBASE, IPA, and CINAHL in September 2023. Inclusion criteria encompassed pharmacist-based CPS reporting economic outcomes or program costs. Studies where the pharmacist's individual economic impact could not be isolated were excluded. Study quality and risk of bias were assessed based on study design and the Quality of Health Economic Studies (QHES) instrument for full economic evaluations. Descriptive statistics summarized study characteristics. (PROSPERO #CRD42023449047). A total of 103 articles met inclusion criteria. Of these, 35% were disease state management, 28% general pharmacotherapy monitoring, and 27% targeted drug programs. Intervention settings included 35% hospital sites, 28% ambulatory care, and 9% community pharmacies. Telehealth delivery was reported in 36% of the studies, while 16% focused on outcomes related to reimbursement or return on investment. Economic evaluation types included descriptive (53%), partial evaluations (30%), and full economic evaluations (17%). According to the American College of Clinical Pharmacy process of care components, 57% included patient assessment, medication therapy evaluation, care plan development and implementation, and follow-up evaluation. The median and interquartile range (IQR) QHES score for the full evaluations was 68 (46–82) out of 100. This review highlights the need for improved methodological rigor and comprehensive economic evaluations to support the long-term viability and reimbursement of CPS, particularly among services delivered via telehealth.