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Structured Pharmacist Review of Medication in Older Hospitalised Patients: A Cost-Effectiveness Analysis

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Abstract

Background

A recent cluster randomised controlled trial (RCT) conducted in an Irish hospital evaluating a structured pharmacist review of medication (SPRM), supported by computerised clinical decision support software (CDSS), demonstrated positive outcomes in terms of reduction of adverse drug reactions (ADR).

Objective

The aim of this study was to examine the cost effectiveness of pharmacists applying an SPRM in conjunction with CDSS to older hospitalised patients compared with usual pharmaceutical care.

Method

Cost-effectiveness analysis alongside a cluster RCT. The trial was conducted in a tertiary hospital in the south of Ireland. Patients in the intervention arm (n = 361) received a multifactorial intervention consisting of medicines reconciliation, deployment of CDSS and generation of a pharmaceutical care plan. Patients in the control arm (n = 376) received usual care from the hospital pharmacy team. Incremental cost effectiveness was examined in terms of costs to the healthcare system and an outcome measure of ADRs during an inpatient hospital stay. Uncertainty in the analysis was explored using a cost-effectiveness acceptability curve (CEAC).

Results

On average, the intervention arm was the dominant strategy in terms of cost effectiveness. Compared with usual care (control), the intervention was associated with a decrease of €807 [95 % confidence interval (CI) −3443 to 1829; p = 0.548) in mean healthcare cost, and a decrease in the mean number of ADR events per patient of −0.064 (95 % CI −0.135 to 0.008; p = 0.081). The probability of the intervention being cost effective at respective threshold values of €0, €250, €500, €750, €1000 and €5000 was 0.707, 0.713, 0.716, 0.718, 0.722 and 0.784, respectively.

Conclusions

Based on the evidence presented, SPRM/CDSS is likely to be determined to be cost effective compared with usual pharmaceutical care. However, neither incremental costs nor effects demonstrated a statistically significant difference, therefore the results of this single-site study should be interpreted with caution.

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Author contributions

James Gallagher, Stephen Byrne and Suzanne McCarthy wrote the manuscript; James Gallagher, Suzanne McCarthy, Paddy Gillespie and Noel Woods analysed the data; David O’Sullivan, Denis O’Mahony and Stephen Byrne designed the original research trial; and David O’Sullivan and James Gallagher performed the primary research.

Author information

Authors and Affiliations

  1. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland

    James Gallagher, David O’Sullivan, Suzanne McCarthy & Stephen Byrne

  2. School of Business and Economics, National University of Ireland Galway, Galway, Ireland

    Paddy Gillespie

  3. Centre for Policy Studies, University College Cork, Cork, Ireland

    Noel Woods

  4. Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland

    Denis O’Mahony

  5. School of Medicine, College of Medicine and Health Sciences, Brookfield Complex, University College Cork, Cork, Ireland

    Denis O’Mahony

Authors
  1. James Gallagher
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  2. David O’Sullivan
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  3. Suzanne McCarthy
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  4. Paddy Gillespie
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  5. Noel Woods
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  6. Denis O’Mahony
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  7. Stephen Byrne
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Corresponding author

Correspondence to Stephen Byrne.

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Funding

Funding for this work was provided by the Health Research Board of Ireland (Grant Number HRA_HSR/2010/14).

Conflicts of interest

All authors have completed the Unified Competing Interest form at https://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare the following: David O’Sullivan was funded by a Health Research Board of Ireland grant to conduct this research using the STOPP/START criteria. Denis O’Mahony and Stephen Byrne were members of the development and validation team that created the STOPP/START criteria and are named on a patent of computer software that used these criteria. James Gallagher, Suzanne McCarthy, Paddy Gillespie and Noel Woods have no conflicts of interest relevant to the content of this study.

Ethical approval

The trial protocol was approved by the Biomedical Ethics Committee (Institutional Review Board) of the University College Cork teaching hospital network.

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Gallagher, J., O’Sullivan, D., McCarthy, S. et al. Structured Pharmacist Review of Medication in Older Hospitalised Patients: A Cost-Effectiveness Analysis. Drugs Aging 33, 285–294 (2016). https://doi.org/10.1007/s40266-016-0348-3

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  • DOI: https://doi.org/10.1007/s40266-016-0348-3

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