Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients
- 707 Downloads
Drug related problems have a significant clinical and economic burden on patients and the healthcare system. Medication review with follow-up (MRF) is a professional pharmacy service aimed at improving patient’s health outcomes through an optimization of the medication.
To ascertain the economic impact of the MRF service provided in community pharmacies to aged polypharmacy patients comparing MRF with usual care, by undertaking a cost analysis and a cost-benefit analysis.
The economic evaluation was based on a cluster randomized controlled trial. Patients in the intervention group (IG) received the MRF service and the comparison group (CG) received usual care. The analysis was conducted from the national health system (NHS) perspective over 6 months. Direct medical costs were included and expressed in euros at 2014 prices. Health benefits were estimated by assigning a monetary value to the quality-adjusted life years. One-way deterministic sensitivity analysis was undertaken in order to analyse the uncertainty.
The analysis included 1403 patients (IG: n = 688 vs CG: n = 715). The cost analysis showed that the MRF saved 97 € per patient in 6 months. Extrapolating data to 1 year and assuming a fee for service of 22 € per patient-month, the estimated savings were 273 € per patient-year. The cost-benefit ratio revealed that for every 1 € invested in MRF, a benefit of 3.3 € to 6.2 € was obtained.
The MRF provided health benefits to patients and substantial cost savings to the NHS. Investment in this service would represent an efficient use of healthcare resources.
KeywordsPharmaceutical services Pharmacists Medication review Aged Cost and cost analysis Cost-benefit analysis
The authors would like to thank all of the pharmacists who participated in the conSIGUE Program.
We also acknowledge the financial support of the Spanish General Council of Official Colleges of Pharmacists and of CINFA Laboratory.
Amaia Malet-Larrea acknowledges the financial support of the Department of Education, Culture and Language Policy of the Basque Government through its Pre-doctoral Fellowship for Research Personnel in Training.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Chiatti, C., Bustacchini, S., Furneri, G., Mantovani, L., Cristian, M., Misuraca, C., et al.: The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people: a systematic review. Drug Saf. 35(Suppl 1), 73–87 (2012)CrossRefPubMedGoogle Scholar
- 4.Farrell, B., Szeto, W., Shamji, S.: Drug-related problems in the frail elderly. Can. Fam. Phys. 57(2), 168–169 (2011)Google Scholar
- 13.Pharmaceutical Care Forum.: Expert panel. Consensus document. Spanish General Council of Official Colleges of Pharmacists, Madrid (2010) (ISBN: 9788469112434)Google Scholar
- 14.Martínez-Martínez, F., Gastelurrutia, M.A., Benrimoj, S.I., García-Cárdenas, V., Saez-Benito, L., Varas, R.: conSIGUE: clinical, economic and humanistic impact of the medication review with follow-up service in aged polypharmacy patients in Spanish community pharmacy. Spanish General Council of Official Colleges of Pharmacists, Madrid (2014). ISBN 978-84-87276-83-5Google Scholar
- 15.Jodar-Sanchez, F., Malet-Larrea, A., Martin, J.J., Garcia-Mochon, L., Lopez Del Amo, M.P., Martinez-Martinez, F., et al.: Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in Spain: the conSIGUE program. Pharmacoeconomics. 33(6), 599–610 (2015)CrossRefPubMedGoogle Scholar
- 18.BotPLUS web database.: Spanish General Council of Official Colleges of Pharmacists. Madrid. Available from: https://botplusweb.portalfarma.com/. Accessed 15 November 2014
- 19.Order of 14 October 2005, which fixes public prices of health services provided by the Public Health System of Andalusia, BOJA 2010. Available from: http://www.juntadeandalucia.es/boja/2005/210/d28.pdf. Accessed June 12, 2014
- 20.Tariff book of public prices of the Public Health System of the Basque Country, 2014. Osakidetza. Available at: http://www.osakidetza.euskadi.net/r85-ckproc05/es/contenidos/informacion/libro_tarifas/es_libro/tarifas.html. Accessed June 4, 2014
- 21.Decree 81/2009, 16 June, which fixes the public costs of health services of the Canarian Health Service. Available from: http://www.gobiernodecanarias.org/boc/2009/123/boc-2009-123-002.pdf. Accessed June 10, 2014
- 22.Ministry of Health, Social Services and Equalty, Spanish Government. [Weights and costs of DRGs. Ministry rule APv27.0.] (2010). Available from: http://www.msssi.gob.es/estadEstudios/estadisticas/docs/SNS2011_PESOS_COSTES_AP27_DEF.pdf. Accessed July 5, 2014
- 23.Malet-Larrea, A., Goyenechea, E., Garcia-Cardenas, V., Calvo, B., Arteche, J.M., Aranegui, P., et al.: The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. Br. J. Clin. Pharmacol. 82(3), 831–838 (2016)CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Noain A, Garcia-Cardenas V, Gastelurrutia MA, Malet-Larrea A, Martínez-Martínez F, Sabater-Hernández D, Benrimoj SI. Cost analysis of a medication review with follow-up service in Spain. Int J Clin Pharm. Google Scholar
- 25.Casal-Sánchez, C., Losada-Campa, M.J.: Necessary times for the dispensation of electronic prescriptions in Galicia: necessities and processes. Farmacéuticos Comunitarios. 4(2), 52–62 (2012)Google Scholar
- 26.EuroQol Group. Spanish (Spain) version of EQ-5D-3L. Rotterdam (2014)Google Scholar
- 27.Ramos-Goñi, J.M., Rivero-Arias, O.: Eq5d: a command to calculate index values for the EQ-5D quality-of-life instrument. Stata J. 11(1), 120–125 (2011)Google Scholar
- 29.Statistics Collegiate and Community Pharmacies 2012. Spanish General Council of Official Colleges of Pharmacists. Madrid. Available from: http://www.portalfarma.com/Profesionales/infoestadistica/Documents/Estadisticas2012.pdf. Accessed 7 Feb 2015
- 30.Abellán A, Esparza C.: A profile of the elderly in Spain, 2011. Basic statistical indicators. (Informes Portal Mayores no. 127). Madrid. Available from: http://digital.csic.es/bitstream/10261/107721/1/pm-indicadoresbasicos11-1.pdf. Accessed 7 Feb 2015
- 34.Benrimoj, S.I., Langford, J.H., Berry, G., Collins, D., Lauchlan, R., Stewart, K., et al.: Economic impact of increased clinical intervention rates in community pharmacy. A randomised trial of the effect of education and a professional allowance. Pharmacoeconomics. 18(5), 459–468 (2000)CrossRefPubMedGoogle Scholar
- 47.Bernsten, C., Bjorkman, I., Caramona, M., Crealey, G., Frokjaer, B., Grundberger, E., et al.: Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging 18(1), 63–77 (2001)CrossRefPubMedGoogle Scholar
- 49.Touchette DR, Masica AL, Dolor RJ, Schumock GT, Choi YK, Kim Y, et al.: Safety-focused medication therapy management: a randomized controlled trial. J. Am. Pharm. Assoc. (2003) 52(5), 603–12 (2012)Google Scholar