Cost‐Effectiveness of Pharmacist‐Led Deprescribing of<scp>NSAIDs</scp>in Community‐Dwelling Older Adults

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

doi:10.1111/jgs.16388

Cited by 35 publications

(76 citation statements)

References 41 publications

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“…Of those, 74 were excluded and one was not retrieved. The remainder of 14 full EE papers [38][39][40][41][42][43][44][45][46][47][48][49][50][51] were included in the final review (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…All of the included studies, with the exception of one from Taiwan [38], were conducted for Organization for Economic Co-operation and Development countries-three in the UK [39][40][41] and in the Netherlands [42][43][44], two in Spain [45,46] and Canada [47,48], and one in Ireland [49], Chile [50] and the USA [51]. Both EE studies conducted in Spain assessed the same service, the conSIGUE trial.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

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Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations

Romano

Figueira²,

Teixeira³

et al. 2021

PharmacoEconomics

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Background Deprescribing can reduce the use of inappropriate or unnecessary medication; however, the economic value of such interventions is uncertain. Objective This study seeks to identify and synthetise the economic evidence of deprescribing interventions among community-dwelling older adults. Methods Full economic evaluation studies of deprescribing interventions, conducted in the community or primary care settings, in community-dwelling adults aged ≥ 65 years were systematically reviewed. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Two researchers independently screened all retrieved articles according to inclusion and exclusion criteria. The main outcome was the economic impact of the intervention from any perspective, converted into 2019 US Dollars. The World Health Organization threshold of 1 gross domestic product per capita was used to define cost effectiveness. Studies were appraised for methodological quality using the extended Consensus on Health Economics Criteria checklist. Results Of 6154 articles identified by the search strategy, 14 papers assessing 13 different interventions were included. Most deprescribing interventions included some type of medication review with or without a supportive educational component (n = 11, 85%), and in general were delivered within a pharmacist-physician care collaboration. Settings included community pharmacies, primary care/outpatient clinics and patients' homes. All economic evaluations were conducted within a time horizon varying from 2 to 12 months with outcomes in most of the studies derived from a single clinical trial. Main health outcomes were reported in terms of quality-adjusted life-years, prevented number of falls and the medication appropriateness index. Cost effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932 per quality-adjusted life-year, a value above the country's World Health Organization threshold. Overall, 85% of the interventions were cost saving, dominated usual care or were cost effective considering 1 gross domestic product per capita. Nine studies scored > 80% (good) and two scored ≤ 50% (low) on critical quality appraisal. Conclusions There is a growing interest in economic evaluations of deprescribing interventions focused on communitydwelling older adults. Although results varied across setting, time horizon and intervention, most were cost effective according to the World Health Organization threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations

Romano

Figueira²,

Teixeira³

et al. 2021

PharmacoEconomics

View full text Add to dashboard Cite

show abstract

“…• Bisphosphonates for postmenopausal women to reduce fracture risk after 19 months 32 • Cholinesterase inhibitors and memantine for Alzheimer's disease after 12 months with cognition and/or functional status worsening 33 • Nonsteroidal antiinflammatory medications (NSAIDs) if symptoms have completely resolved 34,35 • Potentially inappropriate medications 37 • Proton pump inhibitors for GERD after 4 to 8 weeks [38][39][40] • HMG-CoA reductase Inhibitors (ie, Statins) for primary prevention of cerebrovascular events after 5 to 10 years [41][42] • Stool softeners 43 Abbreviations: ADEs, adverse drug events; GERD, gastroesophageal reflux disease. medication review time and positive impact on clinical inertia, and can measure an initiative's impact directly.…”

Section: Discussionmentioning

confidence: 99%

How to implement deprescribing into clinical practice

Pruskowski

Jeffery

Brandt

et al. 2021

J Am Coll Clin Pharm

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We currently live in the age of medication overload. More than 40% of older adults (≥65 years old) are prescribed ≥5 medications a day and nearly 20% take ≥10.Although medications can provide a wide variety of benefits, the number of medications prescribed is the largest predictor of drug-drug interactions, nonadherence, and most importantly adverse drug events. Increasingly, patients, caregivers, and health care providers are employing deprescribing efforts as a solution to medication overload. Clinical pharmacists are well positioned to lead and/or contribute to deprescribing efforts. Deprescribing, however, is not commonly and consistently taught within the United States health professional curriculums, and deprescribing infrastructure support is currently limited. The goal of this review is to present a pragmatic approach to pharmacist-driven clinical practice deprescribing implementation.

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“…Canadian researchers Sanyal and colleagues 28 looked at the cost-effectiveness of a community pharmacist-led education program for community dwelling older adults to support NSAID discontinuation. They considered a population of older adults in the province of Québec and used decision tree and Markov state transition modeling to analyze the cost of such a program.…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Drug Duplication in a Cohort of Older Adults with Dementia

Trenaman

Bowles

Kirkland

et al. 2021

Current Therapeutic Research

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Background Concurrent use of 2 nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, loop diuretics, angiotensin-converting enzyme inhibitors, or anticoagulants is considered potentially inappropriate by Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment criteria. Objective The objective was to examine drug duplication in a cohort of older adults with dementia. Methods Cohort entry for Nova Scotia Seniors’ Pharmacare Program beneficiaries was the date an International Classification of Diseases ninth edition or 10th edition code for dementia was recorded in accessed databases between March 1, 2005, and March 31, 2015. Medication dispensation and sociodemographic data were captured from the Nova Scotia Seniors’ Pharmacare Program database between April 1, 2010, and March 31, 2015. Duplication was considered when 2 drugs from the same class were dispensed such that the supply in the patient's possession could overlap for more than 30 days. We reported number of cases of duplication and duration of overlap. Sex differences in drug duplication were assessed with bivariate logistic regression. Results In the cohort of 28,953 Nova Scotia Seniors’ Pharmacare Program beneficiaries with dementia, we documented concurrent use in 101 (1.7%) nonsteroidal anti-inflammatory drugs users (mean duration = 75.6 days), 95 (1.0%) selective serotonin reuptake inhibitors users (mean duration = 146.6 days), 5 (0.07%) loop diuretic users (mean duration = 530.6 days), 183 (2.0%) angiotensin-converting enzyme inhibitor users (mean duration = 123.9 days), and 160 (3.5%) anticoagulant users (mean duration = 63.6 days). Nonsteroidal anti-inflammatory drug pairs were most commonly celecoxib with naproxen or diclofenac. Selective serotonin reuptake inhibitors duplication was most commonly sertraline with citalopram. No sex differences in risk for drug duplication were identified. Conclusions Drug duplication was identified in a cohort of older adults with dementia and is a feasible target for intervention. ( Curr Ther Res Clin Exp . 2021; 82:XXX–XXX)

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Cost‐Effectiveness of Pharmacist‐Led Deprescribing ofNSAIDsin Community‐Dwelling Older Adults

Cited by 35 publications

References 41 publications

Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations

Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations

How to implement deprescribing into clinical practice

Potentially Inappropriate Drug Duplication in a Cohort of Older Adults with Dementia

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