Cost effectiveness of a GP delivered medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care: the SPPiRE cluster randomised controlled trial.

IF 3.1 3区医学 Q1 ECONOMICS

European Journal of Health Economics Pub Date : 2024-08-27 DOI:10.1007/s10198-024-01718-7

Paddy Gillespie, Frank Moriarty, Susan M Smith, Anna Hobbins, Sharon Walsh, Barbara Clyne, Fiona Boland, Tara McEnteggart, Michelle Flood, Emma Wallace, Caroline McCarthy

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Abstract

Background: Evidence on the cost effectiveness of deprescribing in multimorbidity is limited.

Objective: To investigate the cost effectiveness of a general practitioner (GP) delivered, individualised medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care.

Methods: Within trial economic evaluation, from a healthcare perspective and based on a cluster randomised controlled trial with a 6 month follow up and 403 patients (208 Intervention and 195 Control) recruited between April 2017 and December 2019. Intervention GPs used the SPPiRE website which contained educational materials and a template to support a web-based individualised medication review. Control GPs delivered usual care. Incremental costs, quality adjusted life years (QALYs) generated using the EQ-5D-5L instrument, and expected cost effectiveness were estimated using multilevel modelling and multiple imputation techniques. Uncertainty was explored using parametric, deterministic and probabilistic methods.

Results: On average, the SPPiRE intervention was dominant over usual care, with non-statistically significant mean cost savings of €410 (95% confidence interval (CI): - 2211, 1409) and mean health gains of 0.014 QALYs (95% CI - 0.011, 0.039). At cost effectiveness threshold values of €20,000 and €45,000 per QALY, the probability of SPPiRE being cost effective was 0.993 and 0.988. Results were sensitive to missing data and data collection period.

Conclusions: The study observed a pattern towards dominance for the SPPiRE intervention, with high expected cost effectiveness. Notably, observed differences in costs and outcomes were consistent with chance, and missing data and related uncertainty was non trivial. The cost effectiveness evidence may be considered promising but equivocal.

Trial registration: ISRCTN: 12752680, 20th October 2016.

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由全科医生提供药物审查以减少爱尔兰基层医疗机构中患有多种疾病的老年患者的多药和潜在不当处方的成本效益：SPPiRE 群组随机对照试验。

背景有关对多病症患者取消处方的成本效益的证据很有限：调查由全科医生（GP）提供的个体化用药审查的成本效益，以减少爱尔兰初级医疗机构中多病共存的老年患者的多药并发症和潜在的不当处方：在试验范围内进行经济评估，从医疗保健的角度出发，基于群组随机对照试验，随访 6 个月，在 2017 年 4 月至 2019 年 12 月期间招募了 403 名患者（208 名干预者和 195 名对照者）。干预组全科医生使用 SPPiRE 网站，该网站包含教育材料和模板，支持基于网络的个体化药物审查。对照组全科医生提供常规护理。使用多层次建模和多重估算技术估算了增量成本、使用 EQ-5D-5L 工具生成的质量调整生命年 (QALY) 以及预期成本效益。使用参数、确定性和概率方法探讨了不确定性：平均而言，SPPiRE 的干预效果优于常规护理，平均节约成本 410 欧元（95% 置信区间：- 2211，1409），平均健康收益为 0.014 QALYs（95% 置信区间：- 0.011，0.039）。当成本效益阈值为每 QALY 2 万欧元和 4.5 万欧元时，SPPiRE 具有成本效益的概率分别为 0.993 和 0.988。研究结果对缺失数据和数据收集期很敏感：该研究观察到 SPPiRE 干预的主导模式，其预期成本效益较高。值得注意的是，观察到的成本和结果差异与偶然性一致，数据缺失和相关不确定性并不重要。可以认为，成本效益证据很有希望，但不明确：ISRCTN：12752680，2016年10月20日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Health Economics Multiple-

CiteScore

6.10

自引率

2.30%

发文量

131

期刊介绍： The European Journal of Health Economics is a journal of Health Economics and associated disciplines. The growing demand for health economics and the introduction of new guidelines in various European countries were the motivation to generate a highly scientific and at the same time practice oriented journal considering the requirements of various health care systems in Europe. The international scientific board of opinion leaders guarantees high-quality, peer-reviewed publications as well as articles for pragmatic approaches in the field of health economics. We intend to cover all aspects of health economics: • Basics of health economic approaches and methods • Pharmacoeconomics • Health Care Systems • Pricing and Reimbursement Systems • Quality-of-Life-Studies The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfill the above-mentioned requirements. Officially cited as: Eur J Health Econ