Cost-utility analysis of a pharmacotherapy follow-up for elderly nursing home residents in Spain

Abstract

Objectives: To compare the cost-effectiveness of a pharmacotherapy follow-up for elderly nursing home (NH) residents with that of usual care.

Design: Prospective observational study with a concurrent control group conducted over 12 months.

Setting: Fifteen NHs in Andalusia assigned to control (n = 6) or intervention (n = 9).

Participants: Residents aged 65 and older.

Intervention: Pharmacotherapy follow-up.

Measurements: Negative outcomes associated with medication, health-related quality of life, cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER). ICERs were estimated for three scenarios: unadjusted cost per QALY (first scenario), costs adjusted for baseline prescribed medication and QALYs adjusted for baseline utility score (second scenario), and costs and QALYs adjusted for a fuller set of baseline characteristics (third scenario).

Results: Three hundred thirty-two elderly residents were enrolled: 122 in the control group and 210 in the intervention group. The general practitioner accepted 88.7% (274/309) of pharmacist recommendations. Pharmacist interventions reduced the average number of prescribed medication by 0.47 drugs (P < .001), whereas the average prescribed medication increased by 0.94 drugs in the control group (P < .001). Both groups reported a lower average EuroQol-5D utility score after 12 months (intervention, -0.0576, P = .002; control, -0.0999, P = .003). For the first scenario, usual care dominated pharmacotherapy follow-up (was less effective and more expensive). Adjusted ICERs were € 3,899/QALY ($5,002/QALY) for the second scenario and € 6,574/QALY ($8,433/QALY) for the third scenario. For a willingness to pay of € 30,000/QALY ($38,487/QALY), the probabilities of the pharmacotherapy follow-up being cost-effective were 35% for the first scenario, 78% for the second, and 76% for the third.

Conclusion: Pharmacotherapy follow-up is considered cost-effective for elderly NH residents in Spain.

Keywords: cost-utility analysis; negative outcomes associated with medication; nursing home; pharmacotherapy follow-up; quality-adjusted life-year.