Economic evaluation of a collaborative model of pharmaceutical care in an Irish hospital: cost-utility analysis
Citation:
Kirwan G, O'Leary A, Walsh C, Grimes T, Economic evaluation of a collaborative model of pharmaceutical care in an Irish hospital: cost-utility analysis, HRB Open Research, 6, 19, 2023Download Item:
Abstract:
Background: A complex, collaborative pharmaceutical care
intervention including medication review and reconciliation
demonstrated a statistically significant reduction in the prevalence of
discharge medication error and improved quality of prescribing for
hospitalised adults. This study sought to assess the cost-effectiveness
of this intervention.
Methods: A cost-utility analysis was undertaken using a decision-
analytic framework. The evaluation was undertaken from the Health
Service Executive’s perspective, the payer for primary and secondary
care settings. Direct costs associated with managing hypothetical
harm consequent to intercepted discharge medication error and
consequences in terms of quality-adjusted life years loss were key
input parameters. Analysis was structured within a decision tree
model in Microsoft Excel® populated with consequences as utilities,
estimated costs using macro- and micro-costing approaches, and
event probabilities generated from the original study. Incremental
analysis, one-way and probabilistic sensitivity analyses were
performed.
Results: The results of analysis for the base-care demonstrated that
the intervention dominated standard care with an incremental cost-
effectiveness ratio of -€36,537.24/quality-adjusted life year, indicating
that the intervention is less costly and more effective. The one-way
and probabilistic sensitivity analyses both demonstrated that the
intervention dominated standard care. The model was relatively
robust to variation in input parameters through one-way sensitivity
analysis. The cost of discharge medication error and effect
parameters relating to standard care were most sensitive to change.
Discussion: The analysis demonstrated the cost-effectiveness of a
complex pharmaceutical intervention which will support decisionmaking regarding implementation. This is the first cost-utility analysis
of a complex, collaborative pharmaceutical care intervention, adding
to the scant evidence-base in the field.
Sponsor
Grant Number
The Meath Foundation
Not applicable
Author's Homepage:
http://people.tcd.ie/tagrimesDescription:
PUBLISHED
Author: Grimes, Tamasine
Type of material:
Journal ArticleSeries/Report no:
HRB Open Research6
19
Availability:
Full text availableKeywords:
Hospital discharge, Medication error, Medication reconciliation, Health economics, Cost utility analysis, Pharmaceutical careSubject (TCD):
Inclusive Society , Health Economics , MEDICATION ERRORS , Medication Reconciliation , Medication safety , Patient safetyDOI:
https://doi.org/10.12688/hrbopenres.13679.1Metadata
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