BackgroundThe concept of Pharmaceutical Care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes.
ObjectiveThe objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies, against the alternative of having their medication dispensed normally.
MethodsThe study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of six months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Costutility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as QALYs. In order to analyze the uncertainty of ICER results, we performed a nonparametric bootstrapping with 5,000 replications.
ConclusionMRF service is an effective intervention for optimizing prescribed medication and improving the quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that MRF service is cost effective.
Key points for decision makers-Polypharmacy is a particular concern in older adult populations, and is associated with negative health outcomes.-Medication review with follow-up is a service that attempts to optimize pharmacotherapy, not just by focusing on the process of the use of medication, but also by improving clinical outcomes for older adults.-Medication review with follow-up service is an effective intervention for optimizing prescribed medication and improving the quality of life of older adults with polypharmacy in community pharmacies. Compared with usual dispensing, this service is cost effective.3