Clinical pharmacist-led medication reconciliation supplemented with medication review in admitted patients with chronic kidney disease: a cost-benefit analysis

Abstract

Objective: Chronic kidney disease (CKD) is associated with a high economic burden, which is exacerbated by the high susceptibility to drug-related problems (DRPs) in this patient population. This study aimed to evaluate the cost-benefit ratio of medication reconciliation supplemented with medication review for inpatients with CKD, compared with the absence of this intervention.

Design: This was a cost-benefit analysis conducted along with a prospective interventional study.

Setting: The study was conducted at two hospitals in Jordan between February and May 2023.

Participants: The prospective interventional study included 142 admitted patients with CKD.

Interventions: Patients received medication reconciliation at admission and discharge as well as medication review throughout admission.

Primary and secondary outcome measures: The primary outcome measures were the net benefit and the benefit-to-cost ratio of the intervention. A cost-benefit analysis was conducted from the healthcare system perspective by assessing the cost of the service (the pharmacist time required to complete the service per patient) and the economic benefit, including total and per-patient cost savings and cost avoidance.

Results: The total estimated cost of all DRPs in the absence of interventions (cost avoidance) was $83 052 (average of $585±308 per patient); among which $20 623 was attributed to medication discrepancies. The cost savings were estimated at -$467. The supplemented medication reconciliation service was estimated to cost $714. As a result, the estimated net benefit totalled $81 871, averaging $577 per patient, with a benefit-to-cost ratio of 115.7:1 over the 4-month study period.

Conclusions: Delivering a supplemented medication reconciliation service by a clinical pharmacist for patients with CKD is cost beneficial from the healthcare perspective in Jordan, an example of a low- and middle-income country. This finding further confirms the pivotal role of clinical pharmacists in multidisciplinary healthcare teams.

Keywords: Health & safety; Health Services; Health economics; Medication Reconciliation.

Figure 1. The cost-benefit analysis model. ADE, adverse drug event.

Figure 2. Tornado diagram illustrating the impact of various parameters on the net benefit of supplemented medication reconciliation service (one-way sensitivity analysis). ADE, adverse drug event.

Figure 3. Probabilistic sensitivity analysis evaluating the net benefit of supplemented medication reconciliation service.