Kirwan Gráinne, O'Leary Aisling, Walsh Cathal, Grimes Tamasine
School of Pharmacy and Pharmaceutical Sciences, University of Dublin, Trinity College, Dublin, D02PN40, Ireland.
Pharmacy Department, Tallaght University Hospital, Tallaght, Dublin, D24, Ireland.
HRB Open Res. 2023 Mar 21;6:19. doi: 10.12688/hrbopenres.13679.1. eCollection 2023.
A complex, collaborative pharmaceutical care intervention including medication review and reconciliation demonstrated a statistically significant reduction in the prevalence of discharge medication error and improved quality of prescribing for hospitalised adults. This study sought to assess the cost-effectiveness of this intervention. A cost-utility analysis was undertaken using a decision-analytic framework. The evaluation was undertaken from the Health Service Executive's perspective, the payer for primary and secondary care settings. Direct costs associated with managing hypothetical harm consequent to intercepted discharge medication error and consequences in terms of quality-adjusted life years loss were key input parameters. Analysis was structured within a decision tree model in Microsoft Excel® populated with consequences as utilities, estimated costs using macro- and micro-costing approaches, and event probabilities generated from the original study. Incremental analysis, one-way and probabilistic sensitivity analyses were performed. The results of analysis for the base-care demonstrated that the intervention dominated standard care with an incremental cost-effectiveness ratio of -€36,537.24/quality-adjusted life year, indicating that the intervention is less costly and more effective. The one-way and probabilistic sensitivity analyses both demonstrated that the intervention dominated standard care. The model was relatively robust to variation in input parameters through one-way sensitivity analysis. The cost of discharge medication error and effect parameters relating to standard care were most sensitive to change. The analysis demonstrated the cost-effectiveness of a complex pharmaceutical intervention which will support decision-making regarding implementation. This is the first cost-utility analysis of a complex, collaborative pharmaceutical care intervention, adding to the scant evidence-base in the field.
一项包括药物审查与核对的复杂协作式药学服务干预措施，在统计学上显著降低了出院用药错误的发生率，并改善了住院成人的处方开具质量。本研究旨在评估该干预措施的成本效益。采用决策分析框架进行了成本效用分析。评估是从卫生服务执行局的角度进行的，该局是初级和二级医疗保健机构的付款方。与因拦截出院用药错误导致的假设性伤害管理相关的直接成本以及质量调整生命年损失方面的后果是关键输入参数。分析构建在Microsoft Excel®中的决策树模型内，其中后果作为效用，使用宏观和微观成本核算方法估算成本，并根据原始研究生成事件概率。进行了增量分析、单因素和概率敏感性分析。基础护理的分析结果表明，该干预措施优于标准护理，增量成本效益比为-36,537.24欧元/质量调整生命年，表明该干预措施成本更低且更有效。单因素和概率敏感性分析均表明该干预措施优于标准护理。通过单因素敏感性分析，该模型对输入参数的变化相对稳健。出院用药错误成本和与标准护理相关的效果参数对变化最为敏感。该分析证明了一种复杂药学干预措施的成本效益，这将为实施决策提供支持。这是对一种复杂协作式药学服务干预措施的首次成本效用分析，增加了该领域稀少的证据基础。
