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Cost Effectiveness of a Pharmacist-Led Information Technology Intervention for Reducing Rates of Clinically Important Errors in Medicines Management in General Practices (PINCER)


Background and Objective

We recently showed that a pharmacist-led information technology-based intervention (PINCER) was significantly more effective in reducing medication errors in general practices than providing simple feedback on errors, with cost per error avoided at £79 (US$131). We aimed to estimate cost effectiveness of the PINCER intervention by combining effectiveness in error reduction and intervention costs with the effect of the individual errors on patient outcomes and healthcare costs, to estimate the effect on costs and QALYs.


We developed Markov models for each of six medication errors targeted by PINCER. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. A composite probabilistic model combined patient-level error models with practice-level error rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated from the perspective of NHS England, with a 5-year time horizon.


The PINCER intervention generated £2,679 less cost and 0.81 more QALYs per practice [incremental cost-effectiveness ratio (ICER): −£3,037 per QALY] in the deterministic analysis. In the probabilistic analysis, PINCER generated 0.001 extra QALYs per practice compared with simple feedback, at £4.20 less per practice. Despite this extremely small set of differences in costs and outcomes, PINCER dominated simple feedback with a mean ICER of −£3,936 (standard error £2,970). At a ceiling ‘willingness-to-pay’ of £20,000/QALY, PINCER reaches 59 % probability of being cost effective.


PINCER produced marginal health gain at slightly reduced overall cost. Results are uncertain due to the poor quality of data to inform the effect of avoiding errors.

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We would like to thank the referees for the time they spent reviewing our draft report, and for comments that have helped to improve the final version; the members of the Health Economics Study Group for comments on a submitted paper of this report; Dr Ed Wilson, University of East Anglia, for detailed comments on an earlier draft; and Richard Morriss (Professor of Psychiatry and Community Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham) and Jayne Franklyn (Professor of Medicine and Head of School of Clinical and Experimental Medicine, University of Birmingham) for their clinical input.

Role of the funding source

Funding: Patient Safety Research Program of the UK Department of Health.

The sponsor of the study had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Aziz Sheikh is supported by The Commonwealth Fund, a private independent foundation based in New York City, NY, USA. The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its directors, officers or staff.

This study is registered with Current Controlled Trials: ISRCTN21785299.

Conflicts of interest

The authors (Rachel A. Elliott, Koen Putman, Matthew Franklin, Nick Verhaeghe, Lieven Annemans, Martin Eden, Jasdeep Hayre, Aziz Sheikh, Sarah Rodgers and Anthony J. Avery) declare that they have no competing interests.

Author contributions

Rachel A. Elliott designed and led the economic analysis, including all error models, intervention costs and composite model, led drafting of the manuscript and was on the Trial Management Group.

Koen Putman designed the NSAIDs and β-blockers model, contributed to all other models, built the composite model and was involved in the drafting of the manuscript.

Matthew Franklin designed the lithium model and was involved in the drafting of the manuscript.

Nick Verhaeghe designed the methotrexate and ACEI models and was involved in the drafting of the manuscript.

Lieven Annemans contributed to the design of the composite model and was involved in the drafting of the manuscript.

Martin Eden contributed to intervention cost analysis, CHEERS criteria and was involved in the drafting of the manuscript.

Jasdeep Hayre designed the amiodarone model and was involved in the drafting of the manuscript.

Sarah Rodgers was the trial coordinator from the start of the trial to June 2009 and was involved in the drafting of the manuscript.

Aziz Sheikh contributed to the design and execution of the PINCER trial and was involved in the drafting of the manuscript.

Anthony J. Avery was the principal investigator, had overall responsibility for the day-to-day management of the trial and for the conduct of the trial in the area around Nottingham, and was involved in the drafting of the manuscript.

Rachel A. Elliott will act as overall guarantor.

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Corresponding author

Correspondence to Rachel A. Elliott.

Additional information

On behalf of the PINCER Team.

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Elliott, R.A., Putman, K.D., Franklin, M. et al. Cost Effectiveness of a Pharmacist-Led Information Technology Intervention for Reducing Rates of Clinically Important Errors in Medicines Management in General Practices (PINCER). PharmacoEconomics 32, 573–590 (2014).

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  • Amiodarone
  • Medication Error
  • ACEI Model
  • Simple Feedback
  • Reduce Medication Error