Cost-utility analysis of a structured medication review compared to usual care in Parkinson's disease.

Autor: Oonk NGM; Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands. n.oonk@mst.nl., Dorresteijn LDA; Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands., van den Berg AD; Department of Science and Technology, University of Twente, Enschede, the Netherlands., van der Palen J; Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands.; Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands., Movig KLL; Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands., Nijmeijer HW; Department of Neurology, Ziekenhuis Groep Twente, Almelo, the Netherlands., van Kesteren ME; Department of Neurology, Isala Klinieken, Zwolle, the Netherlands., Koffijberg H; Technical Medical Centre, Section Health Technology and Services Research, University of Twente, Enschede, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of clinical pharmacology [Eur J Clin Pharmacol] 2023 Feb; Vol. 79 (2), pp. 289-297. Date of Electronic Publication: 2022 Dec 23.
DOI: 10.1007/s00228-022-03438-4
Abstrakt: Purpose: For controlling symptoms in Parkinson's disease (PD) together with treating additional comorbidities, patients often face complex medication regimens, with suboptimal adherence, drug-related problems, and diminished therapy efficacy as a common consequence. A medication review could potentially tackle these issues, among others by optimizing drug treatment. Even if no change in clinical outcomes is observed, this intervention might decrease health care costs by reducing drug-related problems and hospital admissions. This study aimed to gain more insight in the health benefits and costs of a structured medication review (SMR) in PD.
Methods: A cost-utility analysis was performed, based on a multicenter randomized controlled trial with 202 PD patients with polypharmacy. The intervention group received an SMR, whereas the control group received usual care. The intervention effect after 6 months of follow-up was presented as incremental quality-adjusted life years (QALY) using the EQ-5D-5L questionnaire. Costs were based on real-world data. Missing data was imputed using multiple imputation techniques. Bootstrapping was used to estimate the uncertainty in all health and economic outcomes.
Results: The QALY gain in the intervention group compared to the control group was - 0.011 (95% CI - 0.043; 0.020). Incremental costs were €433 (95% CI - 873; 1687). When adapting a willingness-to-pay threshold of €20,000/QALY and €80,000/QALY, the probability of SMRs being cost-effective was 18% and 30%, respectively.
Conclusion: A community pharmacist-led SMR in PD patients in the current setting shows no apparent benefit and is not cost-effective after 6 months, compared to usual care.
Trial Registration: Netherlands Trial Register, NL4360. Registered 17 March 2014.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: