title: A cost-effectiveness evaluation of hospital discharge counseling by pharmacists.
abstract: OBJECTIVE
  This study estimated the cost-effectiveness of pharmacist discharge counseling on medication-related morbidity in both the high-risk elderly and general US population.
  
  
  METHODS
  A cost-effectiveness decision analytic model was developed using a health care system perspective based on published clinical trials. Costs included direct medical costs, and the effectiveness unit was patients discharged without suffering a subsequent adverse drug event. A systematic review of published studies was conducted to estimate variable probabilities in the cost-effectiveness model. To test the robustness of the results, a second-order probabilistic sensitivity analysis (Monte Carlo simulation) was used to run 10 000 cases through the model sampling across all distributions simultaneously.
  
  
  RESULTS
  Pharmacist counseling at hospital discharge provided a small, but statistically significant, clinical improvement at a similar overall cost. Pharmacist counseling was cost saving in approximately 48% of scenarios and in the remaining scenarios had a low willingness-to-pay threshold for all scenarios being cost-effective. In addition, discharge counseling was more cost-effective in the high-risk elderly population compared to the general population.
  
  
  CONCLUSIONS
  This cost-effectiveness analysis suggests that discharge counseling by pharmacists is quite cost-effective and estimated to be cost saving in over 48% of cases. High-risk elderly patients appear to especially benefit from these pharmacist services.
authors: Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.
authors: Chanadda
authors: C
authors: Chinthammit
authors: Edward P
authors: EP
authors: Armstrong
authors: Terri L
authors: TL
authors: Warholak
mesh_terms: D000367:Age Factors; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D008962:Models, Theoretical; D010351:Patient Discharge / Q000191:economics*; D010595:Pharmacists / Q000191:economics*; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000458:organization & administration*; D012307:Risk Factors