Abstract
Background Adverse drug events following inappropriate prescribing in the hospital cause a substantial and avoidable medical and economic burden to hospitals, payers and patients alike. A clinical rule-based, pharmacist-led medication-review service, the ‘Check of Medication Appropriateness’ (CMA) was implemented in the University Hospitals Leuven. The CMA is shown to be effective in reducing potentially inappropriate prescriptions. Aim This study investigated whether this centralised clinical pharmacy service is cost-effective. Method We performed a cost-effectiveness analysis of three clinical rules of the CMA, targeting adverse drug events at three levels of severity: A) persistent opioid-induced constipation, B) ketorolac-induced gastrointestinal bleeding and C) drug-induced Torsade de Pointes. A decision tree was developed for each clinical rule. Both intervention costs as well as total costs associated with the occurrence of an adverse drug event were considered. The outcomes were reported in the form of an incremental cost-effectiveness ratio, expressed as an incremental cost per adverse drug event avoided. Results Applying clinical rules to avoid persistent opioid-induced constipation and ketorolac-induced gastrointestinal bleeding were cost-saving. Implementation of a medication check to avoid drug-induced Torsade de Pointes costed €8,846 per Torsade de Pointes avoided. Conclusion Our study provides strong indications that the CMA is worth its investment for clinical rules targeting (very) common adverse drug events, that can be avoided with limited expenses. Further research is required to assess the full CMA. The proposed model may be useful to perform cost-effectiveness analyses of other centralised clinical pharmacy services targeting inappropriate prescribing, at the level of individual adverse drug events.
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20 March 2022
A Correction to this paper has been published: https://doi.org/10.1007/s11096-022-01392-w
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Acknowledgements
We are very grateful for the dedicated work of the IT department in the development of the CMA service.
Funding
This study was supported by internal funding. IS is supported by the Clinical Research Fund of the University Hospitals Leuven. RW and RB are supported as postdoctoral clinical researcher by the Fund for Scientific Research Flanders.
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RW reports research funding from Abbott, Biotronik, Boston Scientific, Medtronic; speakers and consultancy fees from Daichi Sankyo, Bayer, Boehringer Ingelheim, Medtronic, Boston Scientific, Biotronik, Abbott, Microport. RB reports research funding from Fujifilm, Pentax and Medtronic; speakers and consultancy fees from Fujifilm, Pentax, Medtronic, Norgine, CDx diagnostics, Ipsen. None of these are relevant for the content of this paper.
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D’hulster, E., Quintens, C., Bisschops, R. et al. Cost-effectiveness of check of medication appropriateness: methodological approach. Int J Clin Pharm 44, 399–408 (2022). https://doi.org/10.1007/s11096-021-01356-6
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DOI: https://doi.org/10.1007/s11096-021-01356-6