PT - JOURNAL ARTICLE AU - RESPECT Trial Team AU - C Bojke AU - Z Philips AU - M Sculpher AU - P Campion AU - H Chrystyn AU - S Coulton AU - B Cross AU - V Morton AU - S Richmond AU - A Farrin AU - G Hill AU - A Hilton AU - J Miles AU - I Russell AU - I Chi Kei Wong TI - Cost-effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings AID - 10.3399/bjgp09X482312 DP - 2010 Jan 01 TA - British Journal of General Practice PG - e20--e27 VI - 60 IP - 570 4099 - http://bjgp.org/content/60/570/e20.short 4100 - http://bjgp.org/content/60/570/e20.full SO - Br J Gen Pract2010 Jan 01; 60 AB - Background Pharmaceutical care serves as a collaborative model for medication review. Its use is advocated for older patients, although its cost-effectiveness is unknown. Although the accompanying article on clinical effectiveness from the RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) trial finds no statistically significant impact on prescribing for older patients undergoing pharmaceutical care, economic evaluations are based on an estimation, rather than hypothesis testing.Aim To evaluate the cost-effectiveness of pharmaceutical care for older people compared with usual care, according to National Institute for Health and Clinical Excellence (NICE) reference case standards.Methods An economic evaluation was undertaken in which NICE reference case standards were applied to data collected in the RESPECT trial.Results On average, pharmaceutical care is estimated to cost an incremental £10 000 per additional quality-adjusted life year (QALY). If the NHS's cost-effectiveness threshold is between £20 000 and £30 000 per extra QALY, then the results indicate that pharmaceutical care is cost-effective despite a lack of statistical significance to this effect. However, the statistical uncertainty surrounding the estimates implies that the probability that pharmaceutical care is not cost-effective lies between 0.22 and 0.19. Although results are not sensitive to assumptions about costs, they differ between subgroups: in patients aged >75 years pharmaceutical care appears more cost-effective for those who are younger or on fewer repeat medications.Conclusion Although pharmaceutical care is estimated to be cost-effective in the UK, the results are uncertain and further research into its long-term benefits may be worthwhile.