Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-22T22:11:54.409Z Has data issue: false hasContentIssue false
  • English
  • Français

REDUCING POTENTIALLY INAPPROPRIATE PRESCRIBING FOR OLDER PEOPLE IN PRIMARY CARE: COST-EFFECTIVENESS OF THE OPTI-SCRIPT INTERVENTION

Published online by Cambridge University Press:  11 October 2017

Paddy Gillespie ,
Barbara Clyne ,
Adam Raymakers ,
Tom Fahey ,
Carmel M. Hughes  and
Susan M. Smith
Paddy Gillespie
Affiliation:
Health Economics and Policy Analysis Centre, National University of Ireland [email protected]
Barbara Clyne
Affiliation:
HRB Centre for Primary Care Research, Royal College of Surgeons Ireland
Adam Raymakers
Affiliation:
Centre for Research on Medical Devices (CURAM), National University of Ireland Galway
Tom Fahey
Affiliation:
HRB Centre for Primary Care Research, Royal College of Surgeons Ireland
Carmel M. Hughes
Affiliation:
School of Pharmacy, Queens University Belfast
Susan M. Smith
Affiliation:
HRB Centre for Primary Care Research, Royal College of Surgeons Ireland
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: This study examines the cost-effectiveness of the OPTI-SCRIPT intervention on potentially inappropriate prescribing in primary care.

Methods: Economic evaluation, using incremental cost-effectiveness and cost utility analyses, conducted alongside a cluster randomized controlled trial of twenty-one general practices and 196 patients, to compare a multifaceted intervention with usual practice in primary care in Ireland. Potentially inappropriate prescriptions (PIPs) were determined by a pharmacist. Incremental costs, PIPs, and quality-adjusted life-years (QALYs) at 12-month follow-up were estimated using multilevel regression. Uncertainty was explored using cost-effectiveness acceptability curves.

Results: The intervention was associated with a nonsignificant mean cost increase of €407 (95 percent CIs, −357–1170), a significant mean reduction in PIPs of 0.379 (95 percent CI, 0.092–0.666), and a nonsignificant mean increase in QALYs of 0.013 (95 percent CIs, −0.016–0.042). The incremental cost per PIP avoided was €1,269 (95 percent CI, −1400–6302) and the incremental cost per QALY gained was €30,535 (95 percent CI, −334,846–289,498). The probability of the intervention being cost-effective was 0.602 at a threshold value of €45,000 per QALY gained and was at least 0.845 at threshold values of €2,500 per PIP avoided and higher.

Conclusions: While the OPTI-SCRIPT intervention was effective in reducing potentially inappropriate prescribing in primary care in Ireland, our findings highlight the uncertainty with respect to its cost-effectiveness. Further studies are required to explore the health and economic implications of interventions targeting potentially inappropriate prescribing.

Keywords

Cost-effectivenessRandomized controlled trialPotentially inappropriate prescribingPrimary care
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 4: Mini-Theme: Stories of HTA Impact , 2017 , pp. 494 - 503
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Kaufmann, C, Tremp, R, Hersberger, K, Lampert, M. Inappropriate prescribing: A systematic overview of published assessment tools. Eur J Clin Pharmacol. 2014;70:1–11.Google Scholar
2. Spinewine, A, Schmader, K, Barber, N, et al. Appropriate prescribing in elderly people: How well can it be measured and optimised? Lancet. 2007;370:173–184.Google Scholar
3. Hamilton, HJ, Gallagher, PF, O'Mahony, D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr. 2009;9:5.Google Scholar
4. Cahir, C, Fahey, T, Teeling, M, et al. Potentially inappropriate prescribing and cost outcomes for older people: A national population study. Br J Clin Pharmacol. 2010;69:543–552.Google Scholar
5. Cahir, C, Moriarty, F, Teljeur, C, Fahey, T, Bennett, K. Potentially inappropriate prescribing and vulnerability and hospitalization in older community-dwelling patients. Ann Pharmacother. 2014;48:1546–1554.Google Scholar
6. Majumdar, SR, Soumerai, SB. Why most interventions to improve physician prescribing do not seem to work. CMAJ. 2003;169:30–31.Google Scholar
7. Grimshaw, JM, Shirran, L, Thomas, R, et al. Changing provider behavior: An overview of systematic reviews of interventions. Med Care. 2001;39:II2–II45.Google Scholar
8. Bregnhoj, L, Thirstrup, S, Kristensen, M, Bjerrum, L, Sonne, J. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care. Eur J Clin Pharmacol. 2009;65:199–207.Google Scholar
9. Rognstad, S, Brekke, M, Fetveit, A, Dalen, I, Straand, J. Prescription peer academic detailing to reduce inappropriate prescribing for older patients: A cluster randomised controlled trial. Br J Gen Pract. 2013;63:e554–e562.Google Scholar
10. Clyne, B, Smith, SM, Hughes, CM, et al. Effectiveness of a multifaceted intervention for potentially inappropriate prescribing in older patients in primary care: A cluster-randomized controlled trial (OPTI-SCRIPT Study). Ann Fam Med. 2015;13:545–553.Google Scholar
11. Clyne, B, Bradley, M, Hughes, C, et al. Addressing potentially inappropriate prescribing in older patients: Development and pilot study of an intervention in primary care (the OPTI-SCRIPT study). BMC Health Serv Res. 2013;13:307.Google Scholar
12. Clyne, B, Bradley, MC, Smith, SM, et al. Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: A cluster randomized trial (OPTI-SCRIPT study protocol). Trials. 2013;14:72.CrossRefGoogle ScholarPubMed
13. Clyne, B, Smith, S, Hughes, C, et al. Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study). Implementat Sci. 2016;11:79.Google Scholar
14. Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2015.Google Scholar
15. Health Information and Quality Authority. Guidelines for the economic evaluation of health technologies in Ireland. Dublin: Health Information and Quality Authority; 2010.Google Scholar
16. The EuroQol Group. EuroQol–A new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.Google Scholar
17. Campbell, MK, Elbourne, DR, Altman, DG. CONSORT statement: Extension to cluster randomised trials. BMJ. 2004;328:702–708.Google Scholar
18. Gomes, M, Ng, ES, Grieve, R, et al. Developing appropriate methods for cost-effectiveness analysis of cluster randomized trials. Med Decis Making. 2012;32:350–361.Google Scholar
19. Fenwick, E, Byford, S. A guide to cost-effectiveness acceptability curves. Br J Psychiatry. 2005;187:106–108.Google Scholar
20. Ng, ES, Grieve, R, Carpenter, JR. Two-stage non-parametric bootstrap sampling with shrinkage correction for clustered data. Stata J. 2013;15:141–164.Google Scholar
21. Rubin, D. Multiple imputation for nonresponse in surveys. Chichester: Wiley; 1987.Google Scholar
22. Moriarty, F, Bennett, K, Cahir, C, Kenny, RA, Fahey, T. Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: A prospective cohort study. Br J Clin Pharmacol. 2016;82:849–857. doi:10.1111/bcp.12995.Google Scholar
23. Wallace, E, McDowell, R, Bennett, K, Fahey, T, Smith, SM. Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study. J Gerontol A Biol Sci Med Sci. 2017;72:271–277. doi:10.1093/gerona/glw140.Google Scholar
24. Yourman, L, Concato, J, Agostini, JV. Use of computer decision support interventions to improve medication prescribing in older adults: A systematic review. Am J Geriatr Pharmacother. 2008;6:119–129.Google Scholar
25. Kaur, S, Mitchell, G, Vitetta, L, Roberts, MS. Interventions that can reduce inappropriate prescribing in the elderly: A systematic review. Drugs Aging. 2009;26:1013–1028.Google Scholar
Supplementary material: File

Gillespie et al supplementary material

Figures S1-S2 and Tables S1-S11

Download Gillespie et al supplementary material(File)
File 52.6 KB