Canadian Pharmacists Association, Ottawa, Ontario, Canada.
Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
J Am Geriatr Soc. 2020 May;68(5):1090-1097. doi: 10.1111/jgs.16388. Epub 2020 Feb 27.
Older adults are often prescribed potentially inappropriate medications associated with adverse health outcomes and increased health services utilization. Developing Pharmacist-led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly (D-PRESCRIBE), a pragmatic randomized clinical trial, demonstrated how a community pharmacist-led evidence-based educational intervention successfully empowered community-dwelling older adults and their physicians to reduce chronic use of inappropriate medications. The objective of this study was to evaluate the cost-effectiveness of the D-PRESCRIBE intervention for discontinuing nonsteroidal anti-inflammatory drugs (NSAIDs).
Cost-effectiveness analysis.
Canada.
Community-dwelling adults aged 65 years and older.
Decision analysis combining decision tree and Markov state transition modeling was developed to estimate the cost-effectiveness of D-PRESCRIBE (NSAIDs) compared with usual care from a Canadian healthcare system perspective with a time horizon of 1 year. Data from the D-PRESCRIBE trial and published literature were used to calculate effectiveness, utilities, and costs. Reference case and scenario analyses were conducted using probabilistic modeling. Sensitivity analyses assessed the robustness of the reference case model.
D-PRESCRIBE (NSAIDs) was less costly (-$1008.61) and more effective (.11 quality-adjusted life-years [QALYs]) than usual care and was the dominant strategy. At willingness-to-pay thresholds of $50 000 per QALY and $100 000 per QALY, D-PRESCRIBE (NSAIDs) incurred a positive incremental net benefit compared with usual care, suggesting it is cost-effective. Compared with the reference case, scenario analyses gave comparable QALYs with modest variation in cost estimates.
For community-dwelling older adults, D-PRESCRIBE (NSAIDs) provides greater benefits at lower system costs, making it a compelling strategy to reduce the use and harms associated with chronic NSAID consumption. Our findings support reimbursing community pharmacists' clinical professional services for deprescribing inappropriate NSAIDs in community-dwelling older adults. J Am Geriatr Soc 68:1090-1097, 2020.
老年人经常服用潜在不适当的药物，这些药物与不良健康结果和增加的卫生服务利用有关。开展药师主导的研究，以教育和提高社区居民对老年人不当处方负担的认识（D-PRESCRIBE），这是一项实用的随机临床试验，证明了社区药师主导的基于证据的教育干预如何成功地赋予社区居住的老年人及其医生权力，以减少慢性使用不适当的药物。本研究的目的是评估 D-PRESCRIBE 干预措施停止非甾体抗炎药（NSAIDs）的成本效益。
成本效益分析。
加拿大。
65 岁及以上的社区居住成年人。
结合决策树和马尔可夫状态转移建模的决策分析用于从加拿大医疗保健系统的角度估计 D-PRESCRIBE（NSAIDs）与常规护理相比的成本效益，时间范围为 1 年。D-PRESCRIBE 试验和已发表文献的数据用于计算有效性、效用和成本。参考案例和情景分析使用概率建模进行。敏感性分析评估了参考案例模型的稳健性。
D-PRESCRIBE（NSAIDs）比常规护理成本更低（-1008.61 美元），效果更好（0.11 个质量调整生命年[QALYs]），是主导策略。在每 QALY 50000 美元和每 QALY 100000 美元的意愿支付阈值下，与常规护理相比，D-PRESCRIBE（NSAIDs）产生了积极的增量净效益，表明其具有成本效益。与参考案例相比，情景分析在成本估计略有变化的情况下给出了可比的 QALYs。
对于社区居住的老年人，D-PRESCRIBE（NSAIDs）以较低的系统成本提供了更大的益处，使其成为减少慢性 NSAID 消费相关使用和危害的有力策略。我们的研究结果支持为社区药师提供的临床专业服务报销，以减少社区居住的老年人中不适当的 NSAIDs 的使用。J Am Geriatr Soc 68:1090-1097, 2020。
