TY - JOUR
T1 - Cost-utility analysis of a structured medication review compared to usual care in Parkinson’s disease
AU - Oonk, N.G.M.
AU - Dorresteijn, L.D.A.
AU - van den Berg, A.D.
AU - van der Palen, J.
AU - Movig, K.L.L.
AU - Nijmeijer, H.W.
AU - van Kesteren, M.E.
AU - Koffijberg, H.
N1 - Funding Information:
This work was supported by the Royal Dutch Pharmacists Association (Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie, KNMP). This funding had no role in the analysis or interpretation of the results in this study.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/12/23
Y1 - 2022/12/23
N2 - 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.
AB - 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.
KW - Cost-effectiveness analysis
KW - Drug therapy
KW - Medication review
KW - Parkinson’s disease
KW - Pharmacists
KW - Quality of life
KW - UT-Hybrid-D
KW - 2023 OA procedure
UR - http://www.scopus.com/inward/record.url?scp=85144724463&partnerID=8YFLogxK
U2 - 10.1007/s00228-022-03438-4
DO - 10.1007/s00228-022-03438-4
M3 - Article
C2 - 36562830
AN - SCOPUS:85144724463
VL - 79
SP - 289
EP - 297
JO - European journal of clinical pharmacology
JF - European journal of clinical pharmacology
SN - 0031-6970
ER -