Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in Spain: the conSIGUE Program

Abstract

BackgroundThe concept of Pharmaceutical Care is operationalized throughpharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapyand 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. Cost-utility analysisadopted a health serviceperspective. Costs were in euros at 2014 prices and the effectiveness of theintervention was estimated as QALYs. In order to analyze the uncertainty of ICER results, we performed a nonparametric bootstrapping with 5,000 replications.ResultsA total of 1,403 older adults, aged between 65 to 94years,wereenrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28±1.25 drugs; p<0.001) than in the CG (0.07±0.95 drugs; p=0.063).Older adults in the IG saw their quality of life improved by 0.0528±0.20(p<0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022±0.24(p=0.815).The mean total cost was €977.57±1.455,88for the IG and €1,173.44±3,671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of €-250.51±148.61 (95% CI -541.79 to 40.76)and a mean incremental QALY of 0.0156±0.004 (95% CI 0.008 to 0.023). Regarding the results from the cost-utility analysis, the MRFserviceemerged as the dominant strategy.ConclusionMRF service is an effective intervention for optimizing prescribed medication and improving the quality of life in older adultswith 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-upis a service that attempts to optimize pharmacotherapy, not just by focusing on the process of the use of medication, but also by improving clinical outcomesfor older adults.-Medication review with follow-upservice is an effective intervention for optimizing prescribed medication and improving the quality of life of older adultswith polypharmacy in community pharmacies. Compared with usual dispensing, this service is cost effective.