Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients.

Abstract

Drug related problems have a significant clinical and economic burden on patients and the healthcare system. Medication review with follow-up (MRF) is a professional pharmacy service aimed at improving patient's health outcomes through an optimization of the medication. To ascertain the economic impact of the MRF service provided in community pharmacies to aged polypharmacy patients comparing MRF with usual care, by undertaking a cost analysis and a cost-benefit analysis. The economic evaluation was based on a cluster randomized controlled trial. Patients in the intervention group (IG) received the MRF service and the comparison group (CG) received usual care. The analysis was conducted from the national health system (NHS) perspective over 6months. Direct medical costs were included and expressed in euros at 2014 prices. Health benefits were estimated by assigning a monetary value to the quality-adjusted life years. One-way deterministic sensitivity analysis was undertaken in order to analyse the uncertainty. The analysis included 1403 patients (IG: n=688 vs CG: n=715). The cost analysis showed that the MRF saved 97€ per patient in 6months. Extrapolating data to 1year and assuming a fee for service of 22€ per patient-month, the estimated savings were 273€ per patient-year. The cost-benefit ratio revealed that for every 1€ invested in MRF, a benefit of 3.3€ to 6.2€ was obtained. The MRF provided health benefits to patients and substantial cost savings to the NHS. Investment in this service would represent an efficient use of healthcare resources.