Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

Jódar-Sánchez, F; Malet-Larrea, A; Martín, JJ; García-Mochón, L; López del Amo, MP; Martínez-Martínez, F; Gastelurrutia-Garralda, MA; García-Cárdenas, V; Sabater-Hernández, D; Sáez-Benito, L; Benrimoj, SI

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

Jódar-Sánchez, F Malet-Larrea, A Martín, JJ García-Mochón, L López del Amo, MP Martínez-Martínez, F Gastelurrutia-Garralda, MA García-Cárdenas, V

Sabater-Hernández, D

Sáez-Benito, L Benrimoj, SI

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Publication Type:: Journal Article
Citation:: PharmacoEconomics, 2015, 33 (6), pp. 599 - 610
Issue Date:: 2015-06-29

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Field	Value	Language
dc.contributor.author	Jódar-Sánchez, F	en_US
dc.contributor.author	Malet-Larrea, A	en_US
dc.contributor.author	Martín, JJ	en_US
dc.contributor.author	García-Mochón, L	en_US
dc.contributor.author	López del Amo, MP	en_US
dc.contributor.author	Martínez-Martínez, F	en_US
dc.contributor.author	Gastelurrutia-Garralda, MA	en_US
dc.contributor.author	García-Cárdenas, V https://orcid.org/0000-0003-3770-4557	en_US
dc.contributor.author	Sabater-Hernández, D https://orcid.org/0000-0001-7419-8740	en_US
dc.contributor.author	Sáez-Benito, L	en_US
dc.contributor.author	Benrimoj, SI https://orcid.org/0000-0001-9768-7838	en_US
dc.date.available	2020-05-25T19:18:33Z
dc.date.issued	2015-06-29	en_US
dc.identifier.citation	PharmacoEconomics, 2015, 33 (6), pp. 599 - 610	en_US
dc.identifier.issn	1170-7690	en_US
dc.identifier.uri	http://hdl.handle.net/10453/118687
dc.description.abstract	© 2015, Springer International Publishing Switzerland. Background: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. Objective: The 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. Methods: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 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 analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. Results: A total of 1403 older adults, aged between 65 and 94 years, were enrolled 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 ± 1455.88 for the IG and €1173.44 ± 3671.65 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 0.008–0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. Conclusion: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective.	en_US
dc.relation.ispartof	PharmacoEconomics	en_US
dc.relation.isbasedon	10.1007/s40273-015-0270-2	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Polypharmacy	en_US
dc.subject.mesh	Follow-Up Studies	en_US
dc.subject.mesh	Quality-Adjusted Life Years	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Community Pharmacy Services	en_US
dc.subject.mesh	Cost-Benefit Analysis	en_US
dc.subject.mesh	Economics, Pharmaceutical	en_US
dc.subject.mesh	Drug Utilization Review	en_US
dc.subject.mesh	Spain	en_US
dc.subject.mesh	Prescription Drugs	en_US
dc.title	Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program	en_US
dc.type	Journal Article
utslib.citation.volume	6	en_US
utslib.citation.volume	33	en_US
utslib.for	1115 Pharmacology and Pharmaceutical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
utslib.for	14 Economics	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	open_access
pubs.issue	6	en_US
pubs.publication-status	Published	en_US
pubs.volume	33	en_US

Abstract:

© 2015, Springer International Publishing Switzerland. Background: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. Objective: The 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. Methods: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 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 analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. Results: A total of 1403 older adults, aged between 65 and 94 years, were enrolled 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 ± 1455.88 for the IG and €1173.44 ± 3671.65 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 0.008–0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. Conclusion: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective.

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http://hdl.handle.net/10453/118687