title: Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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 6 months. 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.
  
  
  RESULTS
  The analysis included 1403 patients (IG: n = 688 vs CG: n = 715). The cost analysis showed that the MRF saved 97 € per patient in 6 months. Extrapolating data to 1 year 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain. amaia.malet@ehu.eus.
authors.forename: Amaia
authors.initials: A
authors.lastname: Malet-Larrea
authors.affiliation: Official Pharmacist Association of Guipúzcoa, Prim 2, 20006, San Sebastián, Spain.
authors.forename: Estíbaliz
authors.initials: E
authors.lastname: Goyenechea
authors.affiliation: Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gastelurrutia
authors.affiliation: Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Calvo
authors.affiliation: Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: García-Cárdenas
authors.affiliation: Department of Economics, Public University of Navarra, Campus Arrosadía, 31006, Pamplona, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Cabases
authors.affiliation: Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain.
authors.forename: Aránzazu
authors.initials: A
authors.lastname: Noain
authors.affiliation: Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martínez-Martínez
authors.affiliation: Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain.|Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sabater-Hernández
authors.affiliation: Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
authors.forename: Shalom I
authors.initials: SI
authors.lastname: Benrimoj
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D059065:Medication Reconciliation; D010594:Pharmacies; D019338:Polypharmacy; D019057:Quality-Adjusted Life Years
keywords: Aged; Cost and cost analysis; Cost-benefit analysis; Medication review; Pharmaceutical services; Pharmacists