Cost‐utility and cost‐effectiveness analysis of a clinical medication review focused on personal goals in older persons with polypharmacy compared to usual care: Economic evaluation of the DREAMeR study

Verdoorn, Sanne; Pol, Jeroen van de; Hövels, Anke M.; Kwint, Henk-Frans; Blom, Jeanet W.; Gussekloo, Jacobijn; Bouvy, Marcel L.

doi:10.1111/bcp.14421

Cited by 16 publications

(27 citation statements)

References 36 publications

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“…Of those, 74 were excluded and one was not retrieved. The remainder of 14 full EE papers [38][39][40][41][42][43][44][45][46][47][48][49][50][51] were included in the final review (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Most (n = 10) EE studies were published recently, between 2015 and 2021 [38,40,[43][44][45][46][47][48][49][50]. The oldest study was published in 1998 [51].…”

Section: Methods and Inputsmentioning

confidence: 99%

“…The oldest study was published in 1998 [51]. Eleven studies [38-41, 43, 44, 46-50] reported health outcomes in terms of QALYs, three of these also reported additional effectiveness measures-life-years gained, reduction in health-related complaints and mean number of PIPs [39,44,49]. One study reported as an additional outcome the total avoided medical expenditure [38], two expressed results in terms of clinical effectiveness measures only [42,51] and one in terms of monetary benefit [45].…”

Section: Methods and Inputsmentioning

confidence: 99%

“…All of the included studies, with the exception of one from Taiwan [38], were conducted for Organization for Economic Co-operation and Development countries-three in the UK [39][40][41] and in the Netherlands [42][43][44], two in Spain [45,46] and Canada [47,48], and one in Ireland [49], Chile [50] and the USA [51]. Both EE studies conducted in Spain assessed the same service, the conSIGUE trial.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…The remaining two interventions were educational-only services delivered by pharmacists targeting patients taking a specific class of PIMs [47,48]. The interventions were conducted at the community pharmacy (n = 6) [40,41,[44][45][46][47][48], primary care centres/ general practices/geriatric/outpatient clinics (n = 6) [38,42,43,[49][50][51] or at the patient's home (n = 1) [39]. Across settings, most interventions were delivered by a community or clinical pharmacist working in collaboration with a physician, mostly general practitioners [38-41] [44-51].…”

Section: Includedmentioning

confidence: 99%

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Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations

Romano

Figueira²,

Teixeira³

et al. 2021

PharmacoEconomics

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Background Deprescribing can reduce the use of inappropriate or unnecessary medication; however, the economic value of such interventions is uncertain. Objective This study seeks to identify and synthetise the economic evidence of deprescribing interventions among community-dwelling older adults. Methods Full economic evaluation studies of deprescribing interventions, conducted in the community or primary care settings, in community-dwelling adults aged ≥ 65 years were systematically reviewed. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Two researchers independently screened all retrieved articles according to inclusion and exclusion criteria. The main outcome was the economic impact of the intervention from any perspective, converted into 2019 US Dollars. The World Health Organization threshold of 1 gross domestic product per capita was used to define cost effectiveness. Studies were appraised for methodological quality using the extended Consensus on Health Economics Criteria checklist. Results Of 6154 articles identified by the search strategy, 14 papers assessing 13 different interventions were included. Most deprescribing interventions included some type of medication review with or without a supportive educational component (n = 11, 85%), and in general were delivered within a pharmacist-physician care collaboration. Settings included community pharmacies, primary care/outpatient clinics and patients' homes. All economic evaluations were conducted within a time horizon varying from 2 to 12 months with outcomes in most of the studies derived from a single clinical trial. Main health outcomes were reported in terms of quality-adjusted life-years, prevented number of falls and the medication appropriateness index. Cost effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932 per quality-adjusted life-year, a value above the country's World Health Organization threshold. Overall, 85% of the interventions were cost saving, dominated usual care or were cost effective considering 1 gross domestic product per capita. Nine studies scored > 80% (good) and two scored ≤ 50% (low) on critical quality appraisal. Conclusions There is a growing interest in economic evaluations of deprescribing interventions focused on communitydwelling older adults. Although results varied across setting, time horizon and intervention, most were cost effective according to the World Health Organization threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.

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Section: Resultsmentioning

confidence: 99%

“…Most (n = 10) EE studies were published recently, between 2015 and 2021 [38,40,[43][44][45][46][47][48][49][50]. The oldest study was published in 1998 [51].…”

Section: Methods and Inputsmentioning

confidence: 99%