PHP67 Cost Analysis of Home-Based Medication Reviews in a Multi-Ethnic Asian Population: A Pilot Study

Abstract

COST ANALYSIS OF HOME-BASED MEDICATION REVIEWS IN A MULTI-ETHNIC ASIAN POPULATION: A PILOT STUDY Gan HP1, Koh TW2, Tham TY2, Thumboo J3, Koh HL1, Chew WZ4, Wee HL1 1National University of Singapore, Singapore, Singapore, 2Frontier Healthcare Group, Singapore, Singapore, 3Singapore General Hospital, Outram, Singapore, 4Guardian Pharmacy, Singapore, Singapore OBJECTIVES: To evaluate the feasibility and cost of conducting home-based medication reviews (HBMR) among community-dwelling multi-ethnic Singaporeans and permanent residents. METHODS: In this cross-sectional study, Chinese, Malay and Indian aged 40 and over and on at least 5 medications were referred by their general practitioners (GPs) for HBMR. Patients completed a survey on sociodemographic and clinical information. Pharmacists’ time spent on HBMR and preparing visit reports were captured and assigned a cost based on pharmacists’ average hourly wages. Drug related problems (DRP) were evaluated using the Westerlund DRP classification system, reported to and followed up with the GPs. RESULTS: Of 14 participants referred, 9 consented (64.3%; 6 women; 6 Chinese, 2 Malays, 1 Indian; mean (SD, range) age: 69.3 (10.6, 52 – 86 years). Seven out of the 9 patient were under the care of at least two physicians. Dyslipidemia, hypertension and diabetes are the main condition affecting the participants (100%, 88.9%, 66.7%, respectively). A total of 12 DRP were detected: underuse of medication (n 7, of which 2 were due to non-compliance), overuse of medication (n 1), incorrect timing (n 2) and therapy failure (n 2). Pharmacists spent an average 3.5 hours per home visit. Total programme cost was $787.5 (9 visits x $25/hr x 3.5hr/ visit). Hence, cost per DRP detected was estimated at $65.63. One of the DRP detected was vertigo without treatment. Hence, programme cost may be potentially offset by the savings from avoiding an episode of hospitalization due to fall. CONCLUSIONS: DRP is prevalent and potentially preventable but were undetected in this primary care sample. Hence, there is a role for HBMR. We are currently conducting a longitudinal randomized controlled trial to evaluate the cost-effectiveness of providing and not providing HBMR by collecting direct and indirect costs, health services utilization and health-related quality of life outcomes at baseline and 6-months.