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

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Abstract

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 community-dwelling 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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  1. Centre for Health Evaluation and Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal

    Sónia Romano, Débora Figueira & Inês Teixeira

  2. Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal

    Sónia Romano & Julian Perelman

  3. Centro de Investigação em Saúde Pública, Lisbon, Portugal

    Julian Perelman

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All authors have completed the International Committee of Medical Journal Editors (ICMJE) disclosure form. Sónia Romano, Débora Figueira and Inês Teixeira are employees of the Portuguese National Association of Pharmacies. Julian Perelman has no conflicts of interest to declare.

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SR conceived the study and performed the literature search. Data collection and analysis were performed by all authors (SR, DF, IT and JP). The first draft of the manuscript was written by SR, and all authors reviewed and edited all versions of the manuscript. All authors read and approved the final manuscript.

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Romano, S., Figueira, D., Teixeira, I. et al. Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations. PharmacoEconomics 40, 269–295 (2022). https://doi.org/10.1007/s40273-021-01120-8

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