Cost-consequence analysis evaluating multifaceted clinical pharmacist intervention targeting patient transitions of care from hospital to primary care

AimsDrug-related problems are a common complication in the transition from hospital to primary care and are associated with morbidity and increased health care costs. In this study, we evaluated the cost and consequences of a comprehensive pharmaceutical intervention compared with usual care, comprised of a medication review and patient interview before discharge and follow-up for polypharmacy patients. MethodsThis economic evaluation was embedded within a randomized clinical trial. Patients were randomized to either the basic intervention group (n = 493) which received a medication review, the extended intervention group (n = 476) which received a medication review, discharge interview, and follow-up, or the control group (n = 498) which received standard care. Total health care costs were estimated over a period of 180 days at individual patient level from a health sector perspective. ResultsThe mean cost per patient was lower in the intervention groups (basic, euro16 748; extended, euro15 631) compared with the control group (euro17 288), although these differences did not reach statistical significance. The costs of additional time used on medication reviews, patient interviews, and follow-ups (euro88) were outweighed by a decrease in costs of readmissions. The results of the clinical study favored the extended intervention group on clinical outcomes, with statistical significance on a composite of readmissions or emergency department visits within 180 days after inclusion (hazard ratio 0.77, 95% confidence interval 0.64-0.93). ConclusionsThis comprehensive pharmaceutical intervention was not costly and positive effects were seen in the clinical outcomes, thereby reaching a decrease in total cost per patient on average. The results thus indicate that the intervention is cost-effective and that the positive net effects can justify costs of the intervention.