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Cost–Utility Analysis of a Pharmacotherapy Follow‐Up for Elderly Nursing Home Residents in Spain
Author(s) -
JódarSánchez Francisco,
Martín José J.,
López del Amo M. Puerto,
García Leticia,
AraújoSantos José M.,
Epstein David
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12890
Subject(s) - medicine , pharmacotherapy , psychological intervention , quality adjusted life year , cost–utility analysis , quality of life (healthcare) , pharmacist , observational study , cost effectiveness , pediatrics , physical therapy , emergency medicine , pharmacy , family medicine , nursing , risk analysis (engineering)
Objectives To compare the cost‐effectiveness of a pharmacotherapy follow‐up for elderly nursing home ( NH ) residents with that of usual care. Design Prospective observational study with a concurrent control group conducted over 12 months. Setting Fifteen NH s in Andalusia assigned to control (n = 6) or intervention (n = 9). Participants Residents aged 65 and older. Intervention Pharmacotherapy follow‐up. Measurements Negative outcomes associated with medication, health‐related quality of life, cost, quality‐adjusted life‐year ( QALY ), and incremental cost‐effectiveness ratio ( ICER ). ICERs were estimated for three scenarios: unadjusted cost per QALY (first scenario), costs adjusted for baseline prescribed medication and QALY s adjusted for baseline utility score (second scenario), and costs and QALY s adjusted for a fuller set of baseline characteristics (third scenario). Results Three hundred thirty‐two elderly residents were enrolled: 122 in the control group and 210 in the intervention group. The general practitioner accepted 88.7% (274/309) of pharmacist recommendations. Pharmacist interventions reduced the average number of prescribed medication by 0.47 drugs ( P < .001), whereas the average prescribed medication increased by 0.94 drugs in the control group ( P < .001). Both groups reported a lower average EuroQol‐5D utility score after 12 months (intervention, −0.0576, P = .002; control, −0.0999, P = .003). For the first scenario, usual care dominated pharmacotherapy follow‐up (was less effective and more expensive). Adjusted ICER s were €3,899/ QALY ($5,002/ QALY ) for the second scenario and €6,574/ QALY ($8,433/ QALY ) for the third scenario. For a willingness to pay of €30,000/ QALY ($38,487/ QALY ), the probabilities of the pharmacotherapy follow‐up being cost‐effective were 35% for the first scenario, 78% for the second, and 76% for the third. Conclusion Pharmacotherapy follow‐up is considered cost‐effective for elderly NH residents in Spain.