Exploratory Study: The Relationship between the Pharmacy Extension Solution and the Cost of Care

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Background: Digital health technology (DHT) is capable of improving medication adherence in cystic fibrosis (CF) patients. In turn, good medication adherence may potentially decrease patient health care costs. While DHT is utilized, there is a need to better understand the impact it can have on health care costs.

Methods: The objective of this study is to assess the cost of care in CF patients with the implementation of the Pharmacy Extension Solution (PES). PES, a mobile application with smart buttons, was used by adult CF patients for 6 months. Patients’ health care costs were indirectly measured by assessing healthcare resource utilization (HRU) with and without use of PES. HRU included the number of hospitalizations, duration of hospitalizations, number of outpatient visits, and number of emergency department visits.

Results: A total of 32 cystic fibrosis patients were enrolled. There was no change or slight increase in the 4 healthcare resource utilization categories on average per patient – number of hospitalizations: baseline 1.09, 3 months 1.11, 6 months 1.22; duration of hospitalizations: baseline 11.36 days, 3 months 12.22 days, 6 months 13.22 days; number of outpatient visits: baseline 2.07, 3 months 2.26, 6 months 3.61; number of emergency department visits: baseline 1, at 3 months 0, at 6 months 1.

Conclusion: This study showed the use of DHT in cystic fibrosis patients is associated with an increase in HRU; and therefore an increase in healthcare costs. Additional studies are needed to fully understand the impact DHT has on healthcare costs.

Keywords: cystic fibrosis; mobile application; healthcare cost; medication adherence; health resource utilization


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Recommend0 recommendationsPublished in College of Pharmacy, Virtual Poster Session Spring 2021


  1. San – this is an interesting work. I am curious if it is possible to to have a control group not using the app and see if there are differences in HRU and cost. Just would like to hear your thought if this is feasible. What are the caveats that we need to consider if we have a control? Look forward to hearing your thoughts on this.

    1. Dr. Chaiyakunapruk – Thank you for stopping by my poster. That is great question. I wondered this myself too. I do think this is feasible, but it won’t be without it’s challenges. A few things to consider is ensuring very similar baseline characteristics between groups, especially with disease severity and stability. I say this because, for this study, is it possible that a more severe patient with disease progression may have had more healthcare resource utilization regardless of app usage. Additionally, blinding would not be easy as one group would have an app and the other would not.

  2. Nice work, San! As my son and a neighbor participated in this study it was neat to see the results. Your poster was visually appealing. Loved the graphic in the middle of the poster. What advice would you give a student who was thinking about designing a follow up study to this one?

    1. Dr. Witt – Thank you to you, your family, and your neighbor for being involved! If a future student were to conduct a follow-up study, I would tell him/her to set an app usage requirement. I think there was lots of variability among the participants with app usage for this study. Perhaps require participants to use the app at least twice a day, or something similar. Additionally, I feel like there was a learning curve with the app and participants may have needed time to get acquainted with all the features. So, perhaps giving participants a week to become familiar with the app would be helpful.

  3. Nice work, San! I appreciate the small sample size, but I wonder if you think one interpretation for the increase in HRU is that it actually reflects the patients’ use of the App and, therefore, increased disease awareness? That is, might use of the App tune patients into their disease state more, such that they then are more likely to seek care?

    1. Dr. Keefe – Thank you for stopping by my poster. I do think that is a possible interpretation. By being enrolled in this study and using the app, perhaps patients became more involved in their condition and became more aware. It is definitely hard to tell if that is the case. It would be good to have a post-study survey question assessing that.

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