A budget impact analysis of a clinical medication review of patients in an Irish university teaching hospital

Kearney, Alan; Walsh, Elaine; Kirby, Ann; Halleran, Ciaran; Byrne, Derina; Haugh, Jennifer; Sahm, Laura J.

doi:10.1177/2284240318807726

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…In this study, 66.37% of the PIs had a medium or high likelihood of causing an ADE, which is higher than the other similar studies, which had values of 28.7% [14] and 60.7% [54]. Whilst it could be argued that the Kearney et al study yielded similar results [54], the Gallagher et al study is a lot lower [14]. Upon further inspection however, this study was based upon a random sample of interventions (n = 100) which were then reviewed by two academic pharmacists with hospital pharmacy experience, rather than by five raters, including a GP, as in our study [14].…”

Section: Cost Analysiscontrasting

confidence: 72%

“…A similar study by Gallagher et al reported a cost benefit ratio of 8.64:1 [14]. Another similar study in Ireland, found that the MR provided resulted in a cost benefit ratio of 13.66:1 [54]. In this study, 66.37% of the PIs had a medium or high likelihood of causing an ADE, which is higher than the other similar studies, which had values of 28.7% [14] and 60.7% [54].…”

Section: Cost Analysissupporting

confidence: 43%

“…Another similar study in Ireland, found that the MR provided resulted in a cost benefit ratio of 13.66:1 [54]. In this study, 66.37% of the PIs had a medium or high likelihood of causing an ADE, which is higher than the other similar studies, which had values of 28.7% [14] and 60.7% [54]. Whilst it could be argued that the Kearney et al study yielded similar results [54], the Gallagher et al study is a lot lower [14].…”

Section: Cost Analysismentioning

confidence: 92%

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The Role of the Clinical Pharmacist in an Irish University Teaching Hospital: A Mixed-Methods Study

et al. 2020

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Medication review (MR) is a vital part of the pharmacist’s role in hospital. However, in the South Infirmary Victoria University Hospital (SIVUH), Cork, Ireland, this has not been fully implemented due to resource issues. In addition, the cost of providing this service has not been evaluated. Moreover, it is not clear how other members of the multidisciplinary team e.g., Nurses, value any interventions made as a result of the MR. This mixed methods study assessed the impact of MR in terms of (i) potential clinical harm, (ii) cost avoidance and (iii) the views of nursing staff on the role of the pharmacist. The setting is a 192-bed, voluntary, acute hospital, in the Munster region of Ireland. Study I: The pharmacist provided MR to patients conventionally once a week. Any interventions were then assessed for potential clinical harm and to calculate cost avoidance. Study II: Semi-structured interviews, guided by a topic guide were completed with 12 nurses (11 female). Thematic analysis was used to code the main themes. Main outcome measure: To estimate the cost, cost avoidance, and the net cost benefit ratio of MR provided by pharmacists. Study I: Of 128 patients who received the MR, 113 interventions were made. The estimated cost of providing the MR was €2559 (senior pharmacist). Using €1084 as the cost of an adverse drug event (ADE), the cost avoidance was calculated at €42,330. This led to a net cost benefit of €39,771 (senior pharmacist) which equated to a net cost benefit ratio of 16.5:1. Study II: The main themes were (i) perceptions of pharmacy services, (ii) the role of the pharmacist—past, present and future, and (iii) teamwork and communication. Nurses expressed a desire to have more pharmacists present on the wards.

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Section: Cost Analysiscontrasting

confidence: 72%

Section: Cost Analysissupporting

confidence: 43%

Section: Cost Analysismentioning

confidence: 92%

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The Role of the Clinical Pharmacist in an Irish University Teaching Hospital: A Mixed-Methods Study

et al. 2020

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“…This is the rst study to have strati ed STOPPFrail-de ned PIMs according to the pADE occurring, which helps demonstrate PIMs that pose the greatest risk and which should be prioritised for deprescribing in frail older adults. Over one third of PIMs were rated as either 'medium' (32.4%) or 'high' (4.5%) for the pADE occurring, which is similar to the range of 2.0-66.4% reported in similar studies [21,31,33,40,41]. However, PIMs in this study were most commonly rated as having a 'very low' pADE occurring (43.7%), which is higher compared to these similar studies.…”

Section: Discussionsupporting

confidence: 76%

Cost avoidance of pharmacist-led deprescribing using STOPPFrail for older adults in nursing homes

Hurley,

Byrne,

Walsh

et al. 2023

Preprint

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Background: The Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria aim to reduce inappropriate or unnecessary medications in frail older adults, which should minimise adverse drug events and additional healthcare expenditure. Little is known about the economic outcomes of applying these criteria as an intervention. Aim: To evaluate cost avoidance associated with pharmacist-led application of STOPPFrail to frail older nursing home residents. Method: Pharmacist-identified STOPPFrail-defined PIMs that were deprescribed by patients’ general practitioners were assigned a rating by a multidisciplinary panel, i.e. the probability of an adverse drug event occurring if the PIM was not deprescribed. The intervention’s net cost benefit and cost-benefit ratio were then determined by factoring in ADE cost avoidance (calculated from pADE ratings), direct cost savings (deprescribed medication costs and reimbursement fees), and healthcare professionals’ salaries. Results: Of the 176 PIMs deprescribed across 69 patients, 65 PIMs (36.9%) were rated as having a medium or high probability of an adverse drug event occurring if not deprescribed. With €27,162 for direct cost savings, €61,336 for ADE cost avoidance, and €2,589 for healthcare professionals' salary costs, there was a net cost benefit of €85,909 overall. The cost-benefit ratio was 33.2:1 and remained positive in all scenarios in sensitivity analyses. Conclusion: Pharmacist-led application of STOPPFrail to frail older nursing home residents is associated with significant cost avoidance. Wider implementation of pharmacist interventions in frail older nursing home residents should be considered to reduce PIMs and patient harm, alongside substantial cost savings for healthcare systems.

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Cost benefit analysis of clinical pharmacist interventions in medical intensive care unit in Palestine medical complex: Prospective interventional study

Houso

Hamdan²,

Falaneh³

2022

Saudi Pharmaceutical Journal

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A budget impact analysis of a clinical medication review of patients in an Irish university teaching hospital

Cited by 3 publications

References 14 publications

The Role of the Clinical Pharmacist in an Irish University Teaching Hospital: A Mixed-Methods Study

The Role of the Clinical Pharmacist in an Irish University Teaching Hospital: A Mixed-Methods Study

Cost avoidance of pharmacist-led deprescribing using STOPPFrail for older adults in nursing homes

Cost benefit analysis of clinical pharmacist interventions in medical intensive care unit in Palestine medical complex: Prospective interventional study

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