Economic evaluation of deprescribing in older adults: A systematic review.

Objective: This study aims to synthesize economic evaluation evidence on deprescribing in older adults across settings.

Methods: A comprehensive search was conducted across the PubMed, Embase, and Web of Science databases from inception through June 18, 2025, to identify studies evaluating the economic impact of deprescribing in older adults. Two independent reviewers selected relevant articles, extracted data, and assessed study quality according to the Consolidated Health Economic Evaluation Reporting Standards 2022.

Results: 57 studies were included, covering multiple settings such as communities, outpatient clinics, hospitals, geriatric care facilities, nursing homes, primary care, home, and online platforms. Medication review was the most frequently employed deprescribing strategy, supplemented by education, pharmaceutical care, rounds, and pharmacist independent prescriber. Multiple deprescribing tools were used, including general and custom criteria. Physicians and pharmacists were the primary implementers of deprescribing interventions. Economic evaluation methods included cost, cost-utility, cost-benefit, cost-effectiveness, cost-consequence, and return-on-investment analysis, with various outcome indicators. Quality assessment revealed that the quality of the studies was good or very good, except for three studies that were of poor quality. Most studies (44 of 57) indicated that deprescribing led to cost-saving, medication cost reduction, or improved cost-effectiveness/benefit/utility.

Conclusion: The majority of studies support the economic benefit of deprescribing, although some report negative or inconclusive results. However, this review has some limitations in database retrieval, data abstraction and risk of bias assessment, potentially affecting the findings. The contradiction in economic results stems from a variety of factors, which requires further optimization studies in the future.