RT Journal Article
SR Electronic
T1 Cost-effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e20
OP e27
DO 10.3399/bjgp09X482312
VO 60
IS 570
A1 RESPECT Trial Team
A1 C Bojke
A1 Z Philips
A1 M Sculpher
A1 P Campion
A1 H Chrystyn
A1 S Coulton
A1 B Cross
A1 V Morton
A1 S Richmond
A1 A Farrin
A1 G Hill
A1 A Hilton
A1 J Miles
A1 I Russell
A1 I Chi Kei Wong
YR 2010
UL http://bjgp.org/content/60/570/e20.abstract
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.