Presentation (CTI)

OBJECTIVES: In England, an estimated 237 million medication errors occur annually. While several medication safety interventions exist, most economic evidence has focused on hospital-based interventions. Interventions in primary care are often costly and lack robust cost-effectiveness evidence. This review aims to identify and critically appraise economic evaluations of medication safety interventions in primary care to support policymakers in effective resource allocation.
METHODS: A systematic search of Econlit; MEDLINE; APA PsycInfo; and Embase databases (01/2004-04/2024) identified relevant economic evaluations of medication safety interventions in primary care that reported outcomes such as prescribing errors, adverse drug events, medication-related hospitalisations, or relevant disease-specific outcomes (e.g., gastrointestinal bleed). Abstracts, commentaries, theses, expert opinions, pharmacogenetic interventions, and non-English papers were excluded. Study quality was assessed using CHEERS, CONSORT, QHES, and AdViSHE checklists.
RESULTS: The review identified 38 studies. These examined pharmacist-led medication reviews (n=18), multi-professional medication reviews (n=4), deprescribing (n=6), disease management (n=4), care transitions (n=4), and interventions identifying errors in electronic patient records (n=2). Only few studies focused on interventions in care/nursing homes (n=9) and care transitions (n=4), despite high error risk in these settings. Studies mainly focused on older adults and prescribing errors, overlooking other medication use process aspects. Methods used were cost-effectiveness (n=16), cost-consequence, (n=16) cost-utility (n=3) and cost-benefit (n=3) analyses. Key outcomes were hospital readmissions and Quality of Life (QoL). Most analysis were based on trial data (n=22) and adopted a healthcare cost perspective (n=33). Ten studies used decision models: 4 decision trees, 4 decision tree-Markov hybrids, and 2 Markov models. Thirteen studies found the intervention cost-effective, of which seven were medication reviews. The study quality varied, with most model-based studies lacking transparency in model validation.
CONCLUSIONS: The review identified several cost-effective interventions, mostly pharmacist-led interventions. Key evidence gaps include interventions not focused on aspects other than prescribing, high-risk groups or improving digital functionality/interoperability.