The model indicated that if the CMR takes no longer than 19 minutes to complete it was cost saving. Potential savings ranged from £1 to £20, depending on the time taken (ranging from 19 min to 1 min).
The evidence for effectiveness of CMR was derived from the systematic literature review of randomized controlled trials (RCTs) 2, supplemented by routinely collected data (Hospital Episode Statistics). The model followed a conservative assumption that within the 12-month follow-up there was no difference in term of quality of life between the two groups. The main cost of a CMR was assumed to be the additional time for pharmacists to complete the review. Apart from the cost of CMR, the model incorporates the cost to the NHS of emergency department (ED) visits.
Sensitivity Analysis showed that in the best-case scenario, a CMR that takes no longer than 35 minutes to complete was cost saving. Potential savings ranged from £0.5 to £36, depending on the time taken (ranging from 35 min to 1 min). In the worst case scenario, the CMR was cost incurring. The probability of being readmitted to emergency department increases with age. However, the results were not sensitive to this change and were similar in subgroup of patients 70 yo; ≥75 yo and ≥80 yo.
In conclusion, the present study demonstrates that pharmacist-led CMR has the potential to be a cost saving intervention within a 12 months’ time-horizon. The results were promising and suggest that perusing the analysis of long-term cost-effectiveness is worthwhile.
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- NICE. Scope: Multimorbidity: the assessment, prioritisation and management of care for people with commonly occurring multimorbidity. Natl Inst Heal Care Excell Guid. 2014:1-9.
- Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane database Syst Rev. 2016;2(2):CD008986.