Economic evaluation of sedative deprescribing in older adults by community pharmacists

Justin P. Turner, Chiranjeev Sanyal, Philippe Martin, Cara Tannenbaum

Research output: Contribution to journalArticleResearchpeer-review

21 Citations (Scopus)

Abstract

Background: Sedative use in older adults increases the risk of falls, fractures, and hospitalizations. The D-PRESCRIBE (Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly), pragmatic randomized clinical trial demonstrated that community-based, pharmacist-led education delivered simultaneously to older adults and their primary care providers reduce the use of sedatives by 43% over 6 months. However, the associated health benefits and cost savings have yet to be described. This study evaluates the cost-effectiveness of the D-PRESCRIBE intervention compared to usual care for reducing the use of potentially inappropriate sedatives among older adults. 

Methods: A cost-utility analysis from the public health care perspective of Canada estimated the costs and quality-adjusted life-years (QALYs) associated with the D-PRESCRIBE intervention compared to usual care over a 1-year time horizon. Transition probabilities, intervention effectiveness, utility, and costs were derived from the literature. Probabilistic analyses were performed using a decision tree and Markov model to estimate the incremental cost-effectiveness ratio. 

Results: Compared to usual care, pharmacist-led deprescribing is less costly (−$1392.05 CAD) and more effective (0.0769 QALYs). Using common willingness-to-pay (WTP) thresholds of $50 000 and $100 000, D-PRESCRIBE was the optimal strategy. Scenario analysis indicated the cost-effectiveness of D-PRESCRIBE is sensitive to the rate of deprescribing. 

Conclusions: Community pharmacist-led deprescribing of sedatives is cost-effective, leading to greater quality-of-life and harm reduction among older adults. As the pharmacist's scope of practice expands, consideration should be given to interprofessional models of remuneration for quality prescribing and deprescribing services.

Original languageEnglish
Pages (from-to)1061-1067
Number of pages7
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume76
Issue number6
DOIs
Publication statusPublished - 1 Jun 2021
Externally publishedYes

Keywords

  • Cost-effectiveness
  • Falls
  • Health services
  • Hip fracture
  • Sedatives

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