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Controlled Clinical Trial
. 2017 Apr 26;12(4):e0174513.
doi: 10.1371/journal.pone.0174513. eCollection 2017.

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

Fatma Karapinar-Çarkıt  1 , Ronald van der Knaap  1 , Fatiha Bouhannouch  1 , Sander D Borgsteede  2 , Marjo J A Janssen  1 , Carl E H Siegert  3 , Toine C G Egberts  4   5 , Patricia M L A van den Bemt  6 , Marieke F van Wier  7 , Judith E Bosmans  8
Affiliations
Controlled Clinical Trial

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

Fatma Karapinar-Çarkıt et al. PLoS One. .

Abstract

Background: To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective.

Methods: A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs) was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping.

Results: In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51), and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001). Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847). Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained.

Conclusion: The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events) as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Usual care and COACH program components and the timeline plus measured outcomes.
*discrepancies between medication prescribed pre-admission and medication prescribed in the hospital. CP = community pharmacy, GP = general practitioner, PC = patient counselling, MR = medication reconciliation, t = 1,2,3: 1, 2 and 3 months after discharge respectively
Fig 2
Fig 2. Flowchart of inclusion of patients.
Fig 3
Fig 3. Cost-effectiveness analyses for unplanned rehospitalisations.
(A) Cost-effectiveness plane for the risk of unplanned rehospitalisations. (B) Acceptability curve for the cost-effectiveness analyses.
Fig 4
Fig 4. Cost-effectiveness analyses for drug-related rehospitalisations.
(A) Cost-effectiveness plane for the risk of drug-related rehospitalisations. (B) Acceptability curve for the cost-effectiveness analyses.
Fig 5
Fig 5. Cost-utility analyses.
(A) Cost-effectiveness plane for quality adjusted life years. (B) Acceptability curve for the cost-utility analyses.
See this image and copyright information in PMC

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