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.
abstract: 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 <euro>977.57 ± 1455.88 for the IG and <euro>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 -<euro>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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Technological Innovation Group, Virgen del Rocío University Hospital, Seville, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Jódar-Sánchez
authors.forename: Amaia
authors.initials: A
authors.lastname: Malet-Larrea
authors.forename: José J
authors.initials: JJ
authors.lastname: Martín
authors.forename: Leticia
authors.initials: L
authors.lastname: García-Mochón
authors.forename: M Puerto
authors.initials: MP
authors.lastname: López Del Amo
authors.forename: Fernando
authors.initials: F
authors.lastname: Martínez-Martínez
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gastelurrutia-Garralda
authors.forename: Victoria
authors.initials: V
authors.lastname: García-Cárdenas
authors.forename: Daniel
authors.initials: D
authors.lastname: Sabater-Hernández
authors.forename: Loreto
authors.initials: L
authors.lastname: Sáez-Benito
authors.forename: Shalom I
authors.initials: SI
authors.lastname: Benrimoj
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003157:Community Pharmacy Services / Q000191:economics* / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D017723:Drug Utilization Review / Q000191:economics*; D017850:Economics, Pharmaceutical; D005500:Follow-Up Studies; D006801:Humans; D019338:Polypharmacy; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013030:Spain
chemical_list: D055553:Prescription Drugs