OBJECTIVES:Potentially inappropriate use of antipsychotics raises a serious concern about safety, quality and cost of care for residents in long-term care (LTC). This study aimed to evaluate the cost-effectiveness of the Call for less antipsychotics in long-term care (Clear) initiative compared to baseline (pre-Clear).

METHODS: A model-based cost-effectiveness analysis, from a public-payer perspective, was conducted using secondary data of LTC residents in LTC homes from 2013/14 to 2018/19. Residents’ health resource utilization and QoL outcomes were extracted from multiple administrative databases such as Residential Assessment Instrument, Discharge Abstract Database, National Ambulatory Care Reporting System, Pharma Net, and Medical Services Plan. Six Markov states were modelled, including i) Appropriate antipsychotics, ii) Inappropriate antipsychotics, iii) Inappropriate antipsychotics- 0 day, iv) Inappropriate antipsychotics – 1 to 6 days, v) Inappropriate antipsychotics- 7 days, and vi) Death. The primary outcome was the incremental cost per QALY gained.

RESULTS:A cohort of 37,828 residents was included in the primary analysis. The clear initiative, over ten years, was estimated to have an incremental cost-effectiveness ratio (ICER) of CA$12,326 (2019 CAD) at an incremental cost of CA$5,524 per resident and a QALY gain of 0.45. In the sub-group analysis, the ICERs were even more favourable (lower) for Clear-wave 2 (ICER of CA$8,579 per QALY gained) and Clear-wave 3 (ICER of CA$9,053 per QALY gained). At a willingness-to-pay of CA$50,000, the probability that the Clear initiative is cost-effective was 95%. Sensitivity analysis revealed that a 10% reduction of potentially inappropriate antipsychotics lowered the cost per QALY gained to CA$8,231. In the cost-effectiveness acceptability curve, the probabilities of Clear waves 2 and 3 were 99% cost-effective under the $50K willingness to pay threshold.

CONCLUSIONS:This study demonstrated lower costs and yielded favourable ICERs for Clear. More research is needed to evaluate replication of a similar model of care in other provinces of Canada.