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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
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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 

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