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dc.contributor.authorRobinson, Eirin Guldsten
dc.contributor.authorGyllensten, Hanna
dc.contributor.authorJohansen, Jeanette Schultz
dc.contributor.authorHavnes, Kjerstin
dc.contributor.authorGranås, Anne Gerd
dc.contributor.authorBergmo, Trine Strand
dc.contributor.authorSmåbrekke, Lars
dc.contributor.authorGarcia, Beate Hennie
dc.contributor.authorHalvorsen, Kjell Hermann
dc.date.accessioned2024-01-08T14:30:59Z
dc.date.available2024-01-08T14:30:59Z
dc.date.issued2023-11-22
dc.description.abstractBackground - Older adults are at greater risk of medication-related harm than younger adults. The Integrated Medication Management model is an interdisciplinary method aiming to optimize medication therapy and improve patient outcomes.<p> <p>Objective - We aimed to investigate the cost effectiveness of a medication optimization intervention compared to standard care in acutely hospitalized older adults.<p> <p>Methods - A cost-utility analysis including 285 adults aged ≥ 70 years was carried out alongside the IMMENSE study. Quality-adjusted life years (QALYs) were derived using the EuroQol 5-Dimension 3-Level Health State Questionnaire (EQ-5D-3L). Patient-level data for healthcare use and costs were obtained from administrative registers, taking a healthcare perspective. The incremental cost-effectiveness ratio was estimated for a 12-month follow-up and compared to a societal willingness-to-pay range of €/QALY 27,067–81,200 (NOK 275,000–825,000). Because of a capacity issue in a primary care resulting in extended hospital stays, a subgroup analysis was carried out for non-long and long stayers with hospitalizations < 14 days or ≥ 14 days.<p> <p>Results - Mean QALYs were 0.023 [95% confidence interval [CI] 0.022–0.025] higher and mean healthcare costs were €4429 [95% CI − 1101 to 11,926] higher for the intervention group in a full population analysis. This produced an incremental cost-effectiveness ratio of €192,565/QALY. For the subgroup analysis, mean QALYs were 0.067 [95% CI 0.066–0.070, n = 222] and − 0.101 [95% CI − 0.035 to 0.048, n = 63] for the intervention group in the non-long stayers and long stayers, respectively. Corresponding mean costs were €− 824 [95% CI − 3869 to 2066] and €1992 [95% CI − 17,964 to 18,811], respectively. The intervention dominated standard care for the non-long stayers with a probability of cost effectiveness of 93.1–99.2% for the whole willingness-to-pay range and 67.8% at a zero willingness to pay. Hospitalizations were the main cost driver, and readmissions contributed the most to the cost difference between the groups.<p> <p>Conclusions - According to societal willingness-to-pay thresholds, the medication optimization intervention was not cost effective compared to standard care for the full population. The intervention dominated standard care for the non-long stayers, with a high probability of cost effectiveness.en_US
dc.identifier.citationRobinson, Gyllensten, Johansen, Havnes, Granås, Bergmo, Småbrekke, Garcia, Halvorsen. A Trial-Based Cost-Utility Analysis of a Medication Optimization Intervention Versus Standard Care in Older Adults. Drugs & Aging. 2023;40(12):1143-1155
dc.identifier.cristinIDFRIDAID 2213008
dc.identifier.doi10.1007/s40266-023-01077-7
dc.identifier.issn1170-229X
dc.identifier.issn1179-1969
dc.identifier.urihttps://hdl.handle.net/10037/32370
dc.language.isoengen_US
dc.publisherSpringer Natureen_US
dc.relation.journalDrugs & Aging
dc.rights.holderCopyright 2023 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0en_US
dc.rightsAttribution-NonCommercial 4.0 International (CC BY-NC 4.0)en_US
dc.titleA Trial-Based Cost-Utility Analysis of a Medication Optimization Intervention Versus Standard Care in Older Adultsen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
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