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. 2021 May 5:16:767-779.
doi: 10.2147/CIA.S304074. eCollection 2021.

Economic Evaluations of Interventions to Optimize Medication Use in Older Adults with Polypharmacy and Multimorbidity: A Systematic Review

Maude Laberge  1   2   3 , Caroline Sirois  2   3   4   5 , Carlotta Lunghi  3   6 , Myriam Gaudreault  7 , Yumiko Nakamura  8 , Carolann Bolduc  4 , Marie-Laure Laroche  9   10
Affiliations

Economic Evaluations of Interventions to Optimize Medication Use in Older Adults with Polypharmacy and Multimorbidity: A Systematic Review

Maude Laberge et al. Clin Interv Aging. .

Abstract

Purpose: To conduct a systematic review of the economic impact of interventions intended at optimizing medication use in older adults with multimorbidity and polypharmacy.

Methods: We searched Ovid-Medline, Embase, CINAHL, Ageline, Cochrane, and Web of Science, for articles published between 2004 and 2020 that studied older adults with multimorbidity and polypharmacy. The intervention studied had to be aimed at optimizing medication use and present results on costs.

Results: Out of 3,871 studies identified by the search strategy, eleven studies were included. The interventions involved different provider types, with a majority described as a multidisciplinary team involving a pharmacist and a general practitioner, in the decision-making process. Interventions were generally associated with a reduction in medication expenditure. The benefits of the intervention in terms of clinical outcomes remain limited. Five studies were cost-benefit analyses, which had a net benefit that was either null or positive. Cost-utility and cost-effectiveness analyses resulted in incremental cost-effectiveness ratios that were generally within the willingness-to-pay thresholds of the countries in which the studies were conducted. However, the quality of the studies was generally low. Omission of key cost elements of economic evaluations, including intervention cost and payer perspective, limited interpretability.

Conclusion: Interventions to optimize medication use may provide benefits that outweigh their implementation costs, but the evidence remains limited. There is a need to identify and address barriers to the scaling-up of such interventions, starting with the current incentive structures for pharmacists, physicians, and patients.

Keywords: cost-benefit; cost-effectiveness; cost-utility; economic evaluation; polypharmacy; potentially inappropriate medication.

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Conflict of interest statement

Dr Caroline Sirois reports grants from Fonds de recherche du Québec, during the conduct of the study. The authors declare that they have no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Flow diagram for screening and selection processes. Updated search conducted in May 2020 resulted in 1,145 new records screened, 36 full-text articles assessed, and three studies included in the review.
See this image and copyright information in PMC

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