Introduction

Drug related adverse events occur frequently. The prevention of drug-related morbidity and mortality has become an increasingly important requirement for reducing healthcare expenditures¹. Community pharmacists are ideally placed to provide a range of clinical services, however, frequently cite obstacles such as lack of reimbursement and heavy workloads as barriers to the routine delivery of cognitive services. An important goal for the pharmacy profession is to quantify the economic value of pharmacy services. The contingent valuation (CV) or willingness-to-pay (WTP) method offers one such approach to valuing pharmacy services². The aim of the present pilot study was to measure consumers' willingness to pay for community pharmacy services directed towards reducing the risk of medication related problems and to define factors that influence WTP.

Methodology

WTP was measured using a contingent valuation method that involved asking respondents about their maximum willingness to pay for pharmacists' services. Respondents' WTP through ex post (out-of-pocket) and ex ante (taxation) methods were measured using three hypothetical scenarios illustrating reductions in the risk of medication related problems. Logistic regression and semi-log regression were performed to evaluate the responses of the survey. The questionnaire was administered by a trained interviewer to individuals chosen at random (n=101) in shopping areas within Belfast.

Results

Exploratory factor analysis with varimax rotation was used to identify dimensions underlying the importance of information that pharmacists could provide. Logistic regression and semilog linear regression models were used to: (1) estimate the effect of independent variables on an individual's WTP; and (2) test whether the extent of medication-related problem risk reduction had a statistically significant effect on the amount respondents were willing to pay. Of the 101 individuals surveyed (42 male; 59 female), just over 30% reported having a chronic illness, with 14.8% currently taking 3 or more medications. Nine percent reported experiencing a medication related problem in the previous 12 months, and 5% reported that a household member or close relative had experienced a medication related problem over the same period. Despite the majority of those surveyed agreeing that the pharmacist was an expert in medicines (n=74), and that they were satisfied with pharmacy services (n=91), most reported that they would seek advice from a doctor regarding a medication related problem as opposed to seeking advice at a pharmacy (approx. ratio 80:20). The average WTP amount for a reduction in the risk of a medication related problem was £18.61 (�£13.00) with almost a third (31.7%) indicated a WTP of £25 or over per consultation. The most frequently chosen consultation time was 20 to 30 minutes (57.4%). The WTP amounts were significantly associated with the extent of reduction in risk of a medication related problem (p<0.01).

Conclusion

The present pilot results indicate the value the public place on one extended role of the community pharmacist. The study is currently being expanded to involve a much larger sample to improve the generalisability of the results.

References

1. White TJ, Arakelian A, Rho J. Counting the costs of drug-related adverse events. Pharmacoeconomics 1999; 15: 445-458.
2. Blumenschien K, Johannesson M. Use of contingent valuation to place a monetary value on pharmacy services: An overview and review of the literature. Clinical Therapeutics 1999; 21: 1402-1417.