Cost–utility analysis of blister packaging all outpatient medications for veterans with bipolar disorder, major affective disorder, post‐traumatic stress disorder or schizophrenia

Background Veterans with serious mental illnesses face increased risk of both poor medication adherence and death by overdose or suicide. Blister packaging of medications has been associated with population reductions in suicide in the United Kingdom and may improve adherence. Yet, the lack of studies of cost and outcomes has led to controversy about its use. Objective To conduct a cost‐utility analysis of blister packaging versus bulk dispensing using in a randomized controlled trial among Veterans with serious mental illnesses or substance abuse. Methods We conducted a cost‐utility analysis of a pragmatic randomized controlled trial of 303 Veterans (243 of whom completed the 12‐month trial) with post‐traumatic stress disorder, schizophrenia, bipolar disorder or major affective disorder in a large VA academic medical center in the West from the perspective of the VA. Quality adjusted life years (QALYs) were estimated from a monthly SF‐36. Total healthcare utilization and costs were derived from the VHA Corporate Data Warehouse. Incremental cost‐utility ratio and probabilistic sensitivity analysis were estimated. Costs were modeled with regression. Results Mean total VA healthcare costs (including inpatient, outpatient and pharmacy costs) for intervention and control groups were not statistically different at $28 591 and $30 732, respectively. All subjects survived the 12‐month trial period, with similar mean QALYs (0.59 and 0.58). Conclusions In this group of veterans with serious mental illnesses, our results suggest that blister packaging all outpatient prescription medications was budget‐neutral. Blister packaging may be a cost‐effective barrier to intentional overdose with prescribed medications.