Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital

Abstract

ObjectiveTo evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits.MethodPublished data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature.ResultsThe total cost for the LIMM model was €290 compared to €630 for standard care, in spite of a €39 intervention cost. The main cost offset arose from avoided drug-related readmissions in the Admission part (€262) whereas only €66 was offset in the Discharge part as a result of fewer outpatient visits and correction time. The reduced disutility was estimated to 0.005 quality-adjusted life-years (QALY), indicating that LIMM was a dominant alternative. The probability that the intervention would be cost-effective at a zero willingness to pay for a gained QALY compared to standard care was estimated to 98%.ConclusionsThe LIMM medication reconciliation (at admission and discharge) and medication review was both cost-saving and generated greater utility compared to standard care, foremost owing to avoided drug-related hospital readmissions. When implementing such a review process with a multidisciplinary team, it may be important to consider a learning curve in order to capture the full advantage.

The effect of a pharmaceutical transitional care program on rehospitalisations in internal medicine patients: an interrupted-time-series study

“…additional visits to the community pharmacy or general practitioner for questions or problems with medication. Two studies with transitional pharmaceutical care interventions reported no reduction in overall rehospitalisations but a significant reduction in drug-related rehospitalisations [42, 46]. We saw a non-significant decrease in hospital visits due to a medication reconciliation problem, but this was only shown in a post-hoc analysis and our study was underpowered for this outcome.…”

Results from a project to develop systematic patient focused clinical pharmacy services. The Lund Integrated Medicines Management model

“…It also saved time, at least 2–3 h per patient, for physicians and nurses in hospitals, in primary and community care 17. The model also generated cost savings of €370, for each intervention cost of €42 and gained utility of 0.005 18. The probability that the intervention would be cost effective at a zero willingness to pay for a quality adjusted life year gain was 98%.…”

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

“…Of five evaluations, three studies reported positive results on cost-effectiveness, one study reported non-significant positive results and one study reported no difference in costs between groups [ 17 , 23 – 26 ]. The three positive studies used model-based approaches where the effect of different types of interventions were based on assumptions in decreasing medication errors and adverse drug events [ 23 , 25 , 26 ]. In our economic evaluation we found non-significant differences.…”