REDUCING POTENTIALLY INAPPROPRIATE PRESCRIBING FOR OLDER PEOPLE IN PRIMARY CARE: COST-EFFECTIVENESS OF THE OPTI-SCRIPT INTERVENTION. (11th October 2017)

• Record Type: Journal Article
• Authors: Gillespie, Paddy; Clyne, Barbara; Raymakers, Adam; Fahey, Tom; Hughes, Carmel M.; Smith, Susan M.
• Is Part Of: International journal of technology assessment in health care. Volume 33:Number 4(2017)
• Page Start: 494
• Page End: 503
• Publication Date: 2017-10-11
• Subjects: Cost-effectiveness, -- Randomized controlled trial, -- Potentially inappropriate prescribing, -- Primary care; Medical technology -- Periodicals; Technology assessment -- Periodicals; 610.28
• DOI: 10.1017/S0266462317000782
• Languages: English
• ISSNs: 0266-4623

Abstract

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.