Cost-utility analysis of a consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients.
Cost-benefit analysis
Dementia
Institutionalized patients
Nursing homes
Patient-centered medication review
Psychotropic drugs
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
22 05 2021
22 05 2021
Historique:
received:
19
01
2021
accepted:
11
05
2021
entrez:
23
5
2021
pubmed:
24
5
2021
medline:
8
6
2021
Statut:
epublish
Résumé
Growing evidence shows the effects of psychotropic drugs on the evolution of dementia. Until now, only a few studies have evaluated the cost-effectiveness of psychotropic drugs in institutionalized dementia patients. This study aims to assess the cost-utility of intervention performed in the metropolitan area of Barcelona (Spain) (MN) based on consensus between specialized caregivers involved in the management of dementia patients for optimizing and potentially reducing the prescription of inappropriate psychotropic drugs in this population. This analysis was conducted using the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool. The MAFEIP tool builds up from a variety of surrogate endpoints commonly used across different studies in order to estimate health and economic outcomes in terms of incremental changes in quality adjusted life years (QALYs), as well as health and social care utilization. Cost estimates are based on scientific literature and expert opinion; they are direct costs and include medical visits, hospital care, medical tests and exams and drugs administered, among other concepts. The healthcare costs of patients using the intervention were calculated by means of a medication review that compared patients' drug-related costs before, during and after the use of the intervention conducted in MN between 2012 and 2014. The cost-utility analysis was performed from the perspective of a health care system with a time horizon of 12 months. The tool calculated the incremental cost-effectiveness ratio (ICER) of the intervention, revealing it to be dominant, or rather, better (more effective) and cheaper than the current (standard) care. The ICER of the intervention was in the lower right quadrant, making it an intervention that is always accepted even with the lowest given Willingness to Pay (WTP) threshold value (€15,000). The results of this study show that the intervention was dominant, or rather, better (more effective) and cheaper than the current (standard) care. This dominant intervention is therefore recommended to interested investors for systematic application.
Sections du résumé
BACKGROUND
Growing evidence shows the effects of psychotropic drugs on the evolution of dementia. Until now, only a few studies have evaluated the cost-effectiveness of psychotropic drugs in institutionalized dementia patients. This study aims to assess the cost-utility of intervention performed in the metropolitan area of Barcelona (Spain) (MN) based on consensus between specialized caregivers involved in the management of dementia patients for optimizing and potentially reducing the prescription of inappropriate psychotropic drugs in this population. This analysis was conducted using the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool.
METHODS
The MAFEIP tool builds up from a variety of surrogate endpoints commonly used across different studies in order to estimate health and economic outcomes in terms of incremental changes in quality adjusted life years (QALYs), as well as health and social care utilization. Cost estimates are based on scientific literature and expert opinion; they are direct costs and include medical visits, hospital care, medical tests and exams and drugs administered, among other concepts. The healthcare costs of patients using the intervention were calculated by means of a medication review that compared patients' drug-related costs before, during and after the use of the intervention conducted in MN between 2012 and 2014. The cost-utility analysis was performed from the perspective of a health care system with a time horizon of 12 months.
RESULTS
The tool calculated the incremental cost-effectiveness ratio (ICER) of the intervention, revealing it to be dominant, or rather, better (more effective) and cheaper than the current (standard) care. The ICER of the intervention was in the lower right quadrant, making it an intervention that is always accepted even with the lowest given Willingness to Pay (WTP) threshold value (€15,000).
CONCLUSIONS
The results of this study show that the intervention was dominant, or rather, better (more effective) and cheaper than the current (standard) care. This dominant intervention is therefore recommended to interested investors for systematic application.
Identifiants
pubmed: 34022809
doi: 10.1186/s12877-021-02287-7
pii: 10.1186/s12877-021-02287-7
pmc: PMC8141120
doi:
Substances chimiques
Psychotropic Drugs
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
327Références
Ther Adv Chronic Dis. 2016 Sep;7(5):229-45
pubmed: 27583123
Cochrane Database Syst Rev. 2018 Sep 03;9:CD008165
pubmed: 30175841
Br J Clin Pharmacol. 2019 Dec;85(12):2668-2688
pubmed: 31465121
PLoS Med. 2018 Feb 6;15(2):e1002500
pubmed: 29408901
Age Ageing. 2018 May 01;47(3):430-437
pubmed: 29432518
Dement Geriatr Cogn Disord. 2005;19(5-6):305-15
pubmed: 15785031
Pharmacoeconomics. 2015 Jun;33(6):599-610
pubmed: 25774017
Int J Geriatr Psychiatry. 2005 Aug;20(8):712-21
pubmed: 16035123
Med J Aust. 2018 May 21;208(9):398-403
pubmed: 29747564
Fam Pract. 2017 Aug 1;34(4):437-445
pubmed: 28334979
Expert Rev Pharmacoecon Outcomes Res. 2017 Oct;17(5):431-439
pubmed: 28825502
Cochrane Database Syst Rev. 2016 Feb 12;2:CD009095
pubmed: 26866421
Pharmacoeconomics. 2019 Oct;37(10):1241-1260
pubmed: 31179514
BMJ. 2012 Sep 27;345:e6231
pubmed: 23045258
J Am Geriatr Soc. 2010 Jan;58(1):44-53
pubmed: 20002510
Singapore Med J. 2015 Sep;56(9):493-501
pubmed: 26451051
BMC Pharmacol Toxicol. 2013 Nov 07;14:56
pubmed: 24196341
Int J Geriatr Psychiatry. 2017 Oct;32(10):1094-1103
pubmed: 27640872
Int J Environ Res Public Health. 2019 Aug 16;16(16):
pubmed: 31426382
Neurology. 2006 Dec 26;67(12):2186-91
pubmed: 17190942
Age Ageing. 2019 May 1;48(3):419-425
pubmed: 30806453
Am J Psychiatry. 2016 Mar 1;173(3):252-62
pubmed: 26585409
PLoS Med. 2008 Apr 1;5(4):e76
pubmed: 18384230
BMJ. 2006 Apr 1;332(7544):756-61
pubmed: 16543297
Rev Esp Geriatr Gerontol. 2010 Mar-Apr;45(2):89-96
pubmed: 20189268
BMC Geriatr. 2019 Jan 8;19(1):7
pubmed: 30621606
Int J Clin Pharm. 2018 Oct;40(5):1154-1164
pubmed: 29754251
Cochrane Database Syst Rev. 2018 Mar 30;3:CD007726
pubmed: 29605970
BMJ. 2014 Nov 03;349:g6420
pubmed: 25368388
BMC Med Inform Decis Mak. 2015;15 Suppl 3:S4
pubmed: 26391559
Hum Psychopharmacol. 2011 Jan;26(1):12-20
pubmed: 21394786
Drugs Aging. 2018 Jan;35(1):83-91
pubmed: 29322470
BMJ. 2011 Aug 02;343:d4551
pubmed: 21810886
BMC Health Serv Res. 2020 Mar 2;20(1):157
pubmed: 32122341