背景:关于在多病患者中取消处方的成本效益的证据有限。
目的:为了调查全科医生(GP)的成本效益,个性化药物审查,以减少爱尔兰初级保健中多症老年患者的多重用药和潜在的不当处方。
方法:在试验经济评估中,从医疗保健的角度出发,基于2017年4月至2019年12月期间纳入的一项6个月随访的整群随机对照试验和403例患者(208例干预和195例对照).干预全科医生使用SPPiRE网站,该网站包含教育材料和模板,以支持基于网络的个性化药物审查。控制全科医生提供常规护理。增量成本,使用EQ-5D-5L仪器生成的质量调整寿命年(QALYs),和预期的成本效益是使用多层次建模和多种插补技术进行估计的。不确定性是用参数来探索的,确定性和概率方法。
结果:平均而言,SPPiRE干预在常规护理中占主导地位,平均成本节省为410欧元(95%置信区间(CI):-2211,1409),平均健康收益为0.014QALY(95%CI-0.011,0.039),无统计学意义。在每QALY20,000欧元和45,000欧元的成本效益阈值下,SPPiRE具有成本效益的概率为0.993和0.988.结果对缺失数据和数据收集期敏感。
结论:该研究观察到SPPiRE干预的优势模式,具有较高的预期成本效益。值得注意的是,观察到的成本和结果差异与机会一致,缺失的数据和相关的不确定性是不平凡的。成本效益证据可能被认为是有希望的,但模棱两可。
背景:ISRCTN:12752680,2016年10月20日。
BACKGROUND: Evidence on the cost effectiveness of deprescribing in multimorbidity is limited.
OBJECTIVE: To investigate the cost effectiveness of a general practitioner (GP) delivered, individualised medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care.
METHODS: Within trial economic evaluation, from a healthcare perspective and based on a cluster randomised controlled trial with a 6 month follow up and 403 patients (208 Intervention and 195 Control) recruited between April 2017 and December 2019. Intervention GPs used the SPPiRE website which contained educational materials and a template to support a web-based individualised medication review. Control GPs delivered usual care. Incremental costs, quality adjusted life years (QALYs) generated using the EQ-5D-5L instrument, and expected cost effectiveness were estimated using multilevel modelling and multiple imputation techniques. Uncertainty was explored using parametric, deterministic and probabilistic methods.
RESULTS: On average, the SPPiRE intervention was dominant over usual care, with non-statistically significant mean cost savings of €410 (95% confidence interval (CI): - 2211, 1409) and mean health gains of 0.014 QALYs (95% CI - 0.011, 0.039). At cost effectiveness threshold values of €20,000 and €45,000 per QALY, the probability of SPPiRE being cost effective was 0.993 and 0.988. Results were sensitive to missing data and data collection period.
CONCLUSIONS: The study observed a pattern towards dominance for the SPPiRE intervention, with high expected cost effectiveness. Notably, observed differences in costs and outcomes were consistent with chance, and missing data and related uncertainty was non trivial. The cost effectiveness evidence may be considered promising but equivocal.
BACKGROUND: ISRCTN: 12752680, 20th October 2016.