Cost-utility analysis of a consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients

Abstract

Background Growing evidence shows the effects of psychotropic drugs on the evolution of dementia. Until now, only a few studies have evaluated the cost-effectiveness of psychotropic drugs in institutionalized dementia patients. This study aims to assess the cost-utility of intervention performed in the metropolitan area of Barcelona (Spain) (MN) based on consensus between specialized caregivers involved in the management of dementia patients for optimizing and potentially reducing the prescription of inappropriate psychotropic drugs in this population. This analysis was conducted using the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool. Methods The MAFEIP tool builds up from a variety of surrogate endpoints commonly used across different studies in order to estimate health and economic outcomes in terms of incremental changes in quality adjusted life years (QALYs), as well as health and social care utilization. Cost estimates are based on scientific literature and expert opinion; they are direct costs and include medical visits, hospital care, medical tests and exams and drugs administered, among other concepts. The healthcare costs of patients using the intervention were calculated by means of a medication review that compared patients’ drug-related costs before, during and after the use of the intervention conducted in MN between 2012 and 2014. The cost-utility analysis was performed from the perspective of a health care system with a time horizon of 12 months. Results The tool calculated the incremental cost-effectiveness ratio (ICER) of the intervention, revealing it to be dominant, or rather, better (more effective) and cheaper than the current (standard) care. The ICER of the intervention was in the lower right quadrant, making it an intervention that is always accepted even with the lowest given Willingness to Pay (WTP) threshold value (€15,000). Conclusions The results of this study show that the intervention was dominant, or rather, better (more effective) and cheaper than the current (standard) care. This dominant intervention is therefore recommended to interested investors for systematic application.

Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment

“…The 23 included studies covered a variety of populations and conditions related to dementia. Specifically, 10 (43%) studies focused on AD [ 30 – 39 ], five studies (22%) examined MCI and memory concerns [ 40 – 44 ], and three studies (13%) targeted people with other types of dementia [ 45 – 47 ] (Table 1 ). There were also individual studies that addressed certain dementia prevention or diagnostic strategies for specific populations, including couples with one heterozygous Huntington disease individual [ 48 ], people at risk of dementia without a specific health condition [ 49 ], those with idiopathic normal pressure hydrocephalus (iNPH) [ 50 ], or informal caregivers of people with dementia [ 51 ].…”

“…Eight studies (35%) were conducted in Europe [ 31 , 37 , 42 , 45 , 47 , 49 – 51 ], eight (35%) were conducted in the US [ 32 – 34 , 36 , 39 – 41 , 48 ], and two (9%) were conducted in Canada [ 44 , 46 ]. Additionally, single studies (4% each) were conducted in Australia [ 52 ], Brazil [ 30 ], South Korea [ 43 ], Taiwan [ 38 ], and Thailand [ 35 ].…”

“…Pharmacological interventions were the most evaluated type of intervention in the included studies ( n = 10, 43%) [ 30 – 37 , 41 , 45 ] in relation to memory loss and cognitive decline symptoms. Within this range, rivastigmine, galantamine, and donepezil were from the category of cholinesterase inhibitors primarily approved for the treatment of memory loss.…”

“…Of the 23 studies identified, only 12 studies (52%) provided information on the study setting. Of these, four studies (17%) investigated interventions in both community and residential care settings [ 33 , 40 , 41 , 47 ], five studies (21%) in the community care setting only [ 32 , 36 , 44 , 46 , 51 ], two studies (9%) in the residential care setting [ 45 , 50 ], and one study (4%) in a tertiary hospital setting [ 42 ].…”

“…The distribution of health states (if applicable) varied, with the number of states ranging from three to seven. Specifically, two studies utilized a three-state categorization [ 45 , 51 ], while another two studies employed a seven-state categorization [ 39 , 43 ], which was specifically applied in the context of diagnostic interventions. However, the most frequent number of health states observed in the included studies was four and the most commonly encompassed categories of states were mild, moderate, severe, and death (Table 3 ).…”