OBJECTIVES Older adults are often prescribed potentially inappropriate medications associated with adverse health outcomes and increased health services utilization. Developing Pharmacist‐led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly (D‐PRESCRIBE), a pragmatic randomized clinical trial, demonstrated how a community pharmacist‐led evidence‐based educational intervention successfully empowered community‐dwelling older adults and their physicians to reduce chronic use of inappropriate medications. The objective of this study was to evaluate the cost‐effectiveness of the D‐PRESCRIBE intervention for discontinuing nonsteroidal anti‐inflammatory drugs (NSAIDs). DESIGN Cost‐effectiveness analysis. SETTING Canada. PARTICIPANTS Community‐dwelling adults aged 65 years and older. MEASUREMENTS Decision analysis combining decision tree and Markov state transition modeling was developed to estimate the cost‐effectiveness of D‐PRESCRIBE (NSAIDs) compared with usual care from a Canadian healthcare system perspective with a time horizon of 1 year. Data from the D‐PRESCRIBE trial and published literature were used to calculate effectiveness, utilities, and costs. Reference case and scenario analyses were conducted using probabilistic modeling. Sensitivity analyses assessed the robustness of the reference case model. RESULTS D‐PRESCRIBE (NSAIDs) was less costly (−$1008.61) and more effective (.11 quality‐adjusted life‐years [QALYs]) than usual care and was the dominant strategy. At willingness‐to‐pay thresholds of $50 000 per QALY and $100 000 per QALY, D‐PRESCRIBE (NSAIDs) incurred a positive incremental net benefit compared with usual care, suggesting it is cost‐effective. Compared with the reference case, scenario analyses gave comparable QALYs with modest variation in cost estimates. CONCLUSION For community‐dwelling older adults, D‐PRESCRIBE (NSAIDs) provides greater benefits at lower system costs, making it a compelling strategy to reduce the use and harms associated with chronic NSAID consumption. Our findings support reimbursing community pharmacists’ clinical professional services for deprescribing inappropriate NSAIDs in community‐dwelling older adults. J Am Geriatr Soc 68:1090–1097, 2020

This study highlights the evolving role of unregulated care providers in Canada and presents a set of recommendations for implementation at micro, meso, and macro policy levels.

Background Sedative use in older adults increases the risk of falls, fractures and hospitalisations. The “Developing Pharmacist-led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly” (D-PRESCRIBE), pragmatic randomized clinical trial demonstrated that community-based, pharmacist-led education delivered simultaneously to older adults and their primary care providers reduces 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 one-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.

BackgroundInnovations in eHealth technologies have the potential to help older adults live independently, maintain their quality of life, and to reduce their health system dependency and health care expenditure. The objective of this study was to systematically review and appraise the quality of cost-effectiveness or utility studies assessing eHealth technologies in study populations involving older adults.MethodsWe systematically searched multiple databases (MEDLINE, EMBASE, CINAHL, NHS EED, and PsycINFO) for peer-reviewed studies published in English from 2000 to 2016 that examined cost-effectiveness (or utility) of eHealth technologies. The reporting quality of included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement.ResultsEleven full text articles met the inclusion criteria representing public and private health care systems. eHealth technologies evaluated by these studies includes computerized decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioral therapy, telecare, and telehealth. Overall, the reporting quality of the studies included in the review was varied. Most studies demonstrated efficacy and cost-effectiveness of an intervention using a randomized control trial and statistical modeling, respectively. This review found limited information on the feasibility of adopting these technologies based on economic and organizational factors.ConclusionsThis review identified few economic evaluations of eHealth technologies that included older adults. The quality of the current evidence is limited and further research is warranted to clearly demonstrate the long-term cost-effectiveness of eHealth technologies from the health care system and societal perspectives.

Summary What is known and Objective:  Concern has been expressed regarding the potential over‐prescription of benzodiazepines (BZDs) and their potential for misuse and abuse. Patterns of BZD use can be tracked by prescription monitoring programmes (PMPs). This study reviews the literature examining the impact of PMPs on the use of BZDs. Methods:  Studies published in English from January 1980 to April 2009 were identified though PubMed, EMBASE, IPA, CINHL and Web of Science using MeSH terms: ‘Benzodiazepines’ OR ‘Benzodiazepines/supply and distribution’ AND (‘Social Control, Formal/legislation, jurisprudence’); Emtree terms: ‘drug control’/exp AND ‘benzodiazepine derivative’/exp/mj. A broad search strategy was also used: benzodiazepines; triplicate prescription program; prescription monitoring program; triplicate prescribing; and triplicate prescription policy. Results and Discussion:  This search identified 32 relevant articles that addressed the impact of implementation of a PMP for BZDs in New York State in 1989. Overall, BZD prescribing declined following implementation, but the decline was not consistent across population groups. In particular, marginalized and vulnerable populations, such as persons with chronic mental health disorders, may be disproportionately affected. What is new and Conclusion:  We provide a critical review of the impact of PMPs on the use of BZDs. PM decreases overall use of BZDs, but may have unintended consequences that differentially impact certain populations. Furthermore, research is warranted to understand better the long‐term costs and benefits.