title: Structured Pharmacist Review of Medication in Older Hospitalised Patients: A Cost-Effectiveness Analysis.
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.
  
  
  METHODS
  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.
authors: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland.
authors: James
authors: J
authors: Gallagher
authors: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland.
authors: David
authors: D
authors: O'Sullivan
authors: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland.
authors: Suzanne
authors: S
authors: McCarthy
authors: School of Business and Economics, National University of Ireland Galway, Galway, Ireland.
authors: Paddy
authors: P
authors: Gillespie
authors: Centre for Policy Studies, University College Cork, Cork, Ireland.
authors: Noel
authors: N
authors: Woods
authors: Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.|School of Medicine, College of Medicine and Health Sciences, Brookfield Complex, University College Cork, Cork, Ireland.
authors: Denis
authors: D
authors: O'Mahony
authors: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland. stephen.byrne@ucc.ie.
authors: Stephen
authors: S
authors: Byrne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics / Q000517:prevention & control; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007494:Ireland; D007902:Length of Stay / Q000191:economics; D008297:Male; D059065:Medication Reconciliation / Q000191:economics* / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000379:methods*