IDEAS home Printed from https://ideas.repec.org/a/eee/soceps/v92y2024ics0038012124000363.html
   My bibliography  Save this article

Cost-effectiveness of a medication review intervention for general practitioners and their multimorbid older patients with polypharmacy

Author

Listed:
  • Jungo, Katharina Tabea
  • Salari, Paola
  • Meier, Rahel
  • Bagattini, Michael
  • Spruit, Marco
  • Rodondi, Nicolas
  • Streit, Sven
  • Schwenkglenks, Matthias

Abstract

Older adults with multiple chronic conditions and polypharmacy are at an increased risk of having adverse health outcomes, affecting quality of life and generating costs. Primary care has to be effective to guarantee excellent treatment to these patients, who are among the most vulnerable. This project aimed to assess the cost-effectiveness of a tool aimed at improving general practitioners' (GPs) performance, namely a medication review intervention centered around an electronic clinical decision support system (eCDSS). We performed a pre-planned within-trial cost-effectiveness analysis of the OPTICA trial, a cluster randomized controlled trial in Swiss primary care practices aimed at optimizing medication appropriateness and reducing prescribing omissions. Trial participants were older adults aged ≥65 years with ≥3 chronic conditions and ≥5 medications. The 160 participants in the intervention group received a medication review intervention centered around an eCDSS provided by their GP and followed by shared decision-making with their GP. The 163 participants in the control group had a medication discussion in line with usual care with their GP. Patients were followed-up for 12 months. Considering the clustered structure of the data at GP practice level, we applied Generalized Structural Equation Models (GSEMs) on a multiple imputed sample to estimate intervention effects on costs and quality-adjusted life years (QALYs). The intervention strategy was dominant with cost-savings of CHF 1′857 (95 % confidence interval (CI): CHF -3′620 to −93, p-value <0.039, with CHF 1≅USD 1.11 as of November 2023) and a gain of 0.026 incremental QALYs (95 % CI: 0.013 to 0.040, p-value <0.001) per study participant. In robustness analyses, directions of effects were fully consistent, albeit some effect estimates non-significant. Subgroup analyses suggested stronger effects in men and older adults aged 65–74 years or aged ≥85 years. The medication review intervention led to cost savings and an improvement in quality of life, potentially resulting from an accumulation of multiple small positive intervention effects, such as fewer hospitalizations and nursing visits at home.

Suggested Citation

  • Jungo, Katharina Tabea & Salari, Paola & Meier, Rahel & Bagattini, Michael & Spruit, Marco & Rodondi, Nicolas & Streit, Sven & Schwenkglenks, Matthias, 2024. "Cost-effectiveness of a medication review intervention for general practitioners and their multimorbid older patients with polypharmacy," Socio-Economic Planning Sciences, Elsevier, vol. 92(C).
    • Handle: RePEc:eee:soceps:v:92:y:2024:i:c:s0038012124000363
    DOI: 10.1016/j.seps.2024.101837
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0038012124000363
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.seps.2024.101837?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Joanne Lord & Maxwell A. Asante, 1999. "Estimating uncertainty ranges for costs by the bootstrap procedure combined with probabilistic sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 323-333, June.
    2. Richard Grieve & Richard Nixon & Simon G. Thompson & John Cairns, 2007. "Multilevel models for estimating incremental net benefits in multinational studies," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 815-826, August.
    3. Luiz Flavio Andrade & Kristina Ludwig & Juan Manuel Ramos Goni & Mark Oppe & Gérard Pouvourville, 2020. "A French Value Set for the EQ-5D-5L," PharmacoEconomics, Springer, vol. 38(4), pages 413-425, April.
    4. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    5. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    6. Tor Iversen & Ching‐to Albert Ma, 2022. "Technology adoption by primary care physicians," Health Economics, John Wiley & Sons, Ltd., vol. 31(3), pages 443-465, March.
    7. Paola Salari & Cian O’Mahony & Séverine Henrard & Paco Welsing & Arjun Bhadhuri & Nadine Schur & Marie Roumet & Shanthi Beglinger & Thomas Beck & Katharina Tabea Jungo & Stephen Byrne & Stefanie Hossm, 2022. "Cost-effectiveness of a structured medication review approach for multimorbid older adults: Within-trial analysis of the OPERAM study," PLOS ONE, Public Library of Science, vol. 17(4), pages 1-17, April.
    8. Shahari, Mohd Ridzwan & See, Kok Fong & Mohammed, Noor Syahireen & Yu, Ming-Miin, 2023. "Constructing the performance index of Malaysia’s district health centers using effectiveness-based hierarchical data envelopment analysis," Socio-Economic Planning Sciences, Elsevier, vol. 89(C).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Subal C. Kumbhakar & Christopher F. Parmeter & Valentin Zelenyuk, 2022. "Stochastic Frontier Analysis: Foundations and Advances I," Springer Books, in: Subhash C. Ray & Robert G. Chambers & Subal C. Kumbhakar (ed.), Handbook of Production Economics, chapter 8, pages 331-370, Springer.
    2. Anne Hvenegaard & Jacob Arendt & Andrew Street & Dorte Gyrd-Hansen, 2011. "Exploring the relationship between costs and quality: Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 541-551, December.
    3. Indranil R. Bardhan & Chenzhang Bao & Sezgin Ayabakan, 2023. "Value Implications of Sourcing Electronic Health Records: The Role of Physician Practice Integration," Information Systems Research, INFORMS, vol. 34(3), pages 1169-1190, September.
    4. Emanuela Ghignoni & Maria Maddalena Giannetti, 2020. "Diffusion and mortality of the Covid-19 pandemic in the Italian Provinces: The role of human capital, families' structure, population mobility and local healthcare systems," QUADERNI DI ECONOMIA DEL LAVORO, FrancoAngeli Editore, vol. 2020(111), pages 263-288.
    5. Abhijith Anand & Rajeev Sharma & Rajiv Kohli, 2020. "The Effects of Operational and Financial Performance Failure on BI&A-Enabled Search Behaviors: A Theory of Performance-Driven Search," Information Systems Research, INFORMS, vol. 31(4), pages 1144-1163, December.
    6. Bao Hoang Nguyen & Shawna Grosskopf & Jongsay Yong & Valentin Zelenyuk, 2024. "Activity‐based funding reform and the performance of public hospitals: The case of Queensland, Australia," Economic Inquiry, Western Economic Association International, vol. 62(4), pages 1679-1701, October.
    7. Chenzhang Bao & Indranil R. Bardhan, 2022. "Performance of Accountable Care Organizations: Health Information Technology and Quality–Efficiency Trade-Offs," Information Systems Research, INFORMS, vol. 33(2), pages 697-717, June.
    8. Mengyuan Zhou, 2022. "Does the Source of Inheritance Matter in Bequest Attitudes? Evidence from Japan," Journal of Family and Economic Issues, Springer, vol. 43(4), pages 867-887, December.
    9. Campbell, Randall C. & Nagel, Gregory L., 2016. "Private information and limitations of Heckman's estimator in banking and corporate finance research," Journal of Empirical Finance, Elsevier, vol. 37(C), pages 186-195.
    10. Giuliani, Elisa & Martinelli, Arianna & Rabellotti, Roberta, 2016. "Is Co-Invention Expediting Technological Catch Up? A Study of Collaboration between Emerging Country Firms and EU Inventors," World Development, Elsevier, vol. 77(C), pages 192-205.
    11. Ilona Babenko & Benjamin Bennett & John M Bizjak & Jeffrey L Coles & Jason J Sandvik, 2023. "Clawback Provisions and Firm Risk," The Review of Corporate Finance Studies, Society for Financial Studies, vol. 12(2), pages 191-239.
    12. Şahan, Duygu & Tuna, Okan, 2018. "Environmental innovation of transportation sector in OECD countries," Chapters from the Proceedings of the Hamburg International Conference of Logistics (HICL), in: Kersten, Wolfgang & Blecker, Thorsten & Ringle, Christian M. (ed.), The Road to a Digitalized Supply Chain Management: Smart and Digital Solutions for Supply Chain Management. Proceedings of the Hamburg International C, volume 25, pages 157-170, Hamburg University of Technology (TUHH), Institute of Business Logistics and General Management.
    13. Eric Fesselmeyer & Kiat Ying Seah, 2018. "Individual Payoffs and the Effect of Homeownership on Social Capital Investment," Journal of Housing Research, Taylor & Francis Journals, vol. 27(1), pages 59-78, January.
    14. Ruomeng Cui & Dennis J. Zhang & Achal Bassamboo, 2019. "Learning from Inventory Availability Information: Evidence from Field Experiments on Amazon," Management Science, INFORMS, vol. 65(3), pages 1216-1235, March.
    15. Luiz Paulo Fávero & Joseph F. Hair & Rafael de Freitas Souza & Matheus Albergaria & Talles V. Brugni, 2021. "Zero-Inflated Generalized Linear Mixed Models: A Better Way to Understand Data Relationships," Mathematics, MDPI, vol. 9(10), pages 1-28, May.
    16. Shaikh M. S. U. Eskander & Sam Fankhauser, 2022. "Income Diversification and Income Inequality: Household Responses to the 2013 Floods in Pakistan," Sustainability, MDPI, vol. 14(1), pages 1-12, January.
    17. Iván Fernández-Val & Martin Weidner, 2018. "Fixed Effects Estimation of Large-TPanel Data Models," Annual Review of Economics, Annual Reviews, vol. 10(1), pages 109-138, August.
    18. Peter Harasztosi & Attila Lindner, 2019. "Who Pays for the Minimum Wage?," American Economic Review, American Economic Association, vol. 109(8), pages 2693-2727, August.
    19. Jinwon Kim & Jucheol Moon & Dongyun Yang, 2024. "Pigouvian Congestion Tolls and the Welfare Gain: Estimates for California Freeways," Working Papers 2402, Nam Duck-Woo Economic Research Institute, Sogang University (Former Research Institute for Market Economy).
    20. Cho, Seong-Hoon & Kim, Heeho & Roberts, Roland K. & Kim, Taeyoung & Lee, Daegoon, 2014. "Effects of changes in forestland ownership on deforestation and urbanization and the resulting effects on greenhouse gas emissions," Journal of Forest Economics, Elsevier, vol. 20(1), pages 93-109.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:soceps:v:92:y:2024:i:c:s0038012124000363. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/seps .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.