IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v26y2025i3d10.1007_s10198-024-01718-7.html
   My bibliography  Save this article

Cost effectiveness of a GP delivered medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care: the SPPiRE cluster randomised controlled trial

Author

Listed:
  • Paddy Gillespie

    (University of Galway)

  • Frank Moriarty

    (Royal College of Surgeons in Ireland, University of Medicine and Health Sciences)

  • Susan M. Smith

    (Trinity College Dublin)

  • Anna Hobbins

    (University of Galway)

  • Sharon Walsh

    (University of Galway)

  • Barbara Clyne

    (Royal College of Surgeons in Ireland, University of Medicine and Health Sciences)

  • Fiona Boland

    (Royal College of Surgeons in Ireland, University of Medicine and Health Sciences)

  • Tara McEnteggart

    (Royal College of Surgeons in Ireland, University of Medicine and Health Sciences)

  • Michelle Flood

    (Royal College of Surgeons in Ireland, University of Medicine and Health Sciences)

  • Emma Wallace

    (University College Cork)

  • Caroline McCarthy

    (Royal College of Surgeons in Ireland, University of Medicine and Health Sciences)

Abstract

Background Evidence on the cost effectiveness of deprescribing in multimorbidity is limited. Objective To investigate the cost effectiveness of a general practitioner (GP) delivered, individualised medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care. Methods Within trial economic evaluation, from a healthcare perspective and based on a cluster randomised controlled trial with a 6 month follow up and 403 patients (208 Intervention and 195 Control) recruited between April 2017 and December 2019. Intervention GPs used the SPPiRE website which contained educational materials and a template to support a web-based individualised medication review. Control GPs delivered usual care. Incremental costs, quality adjusted life years (QALYs) generated using the EQ-5D-5L instrument, and expected cost effectiveness were estimated using multilevel modelling and multiple imputation techniques. Uncertainty was explored using parametric, deterministic and probabilistic methods. Results On average, the SPPiRE intervention was dominant over usual care, with non-statistically significant mean cost savings of €410 (95% confidence interval (CI): − 2211, 1409) and mean health gains of 0.014 QALYs (95% CI − 0.011, 0.039). At cost effectiveness threshold values of €20,000 and €45,000 per QALY, the probability of SPPiRE being cost effective was 0.993 and 0.988. Results were sensitive to missing data and data collection period. Conclusions The study observed a pattern towards dominance for the SPPiRE intervention, with high expected cost effectiveness. Notably, observed differences in costs and outcomes were consistent with chance, and missing data and related uncertainty was non trivial. The cost effectiveness evidence may be considered promising but equivocal. Trial registration ISRCTN: 12752680, 20th October 2016.

Suggested Citation

  • Paddy Gillespie & Frank Moriarty & Susan M. Smith & Anna Hobbins & Sharon Walsh & Barbara Clyne & Fiona Boland & Tara McEnteggart & Michelle Flood & Emma Wallace & Caroline McCarthy, 2025. "Cost effectiveness of a GP delivered medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care: the SPPiRE cluster ," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(3), pages 427-454, April.
    • Handle: RePEc:spr:eujhec:v:26:y:2025:i:3:d:10.1007_s10198-024-01718-7
    DOI: 10.1007/s10198-024-01718-7
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-024-01718-7
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-024-01718-7?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Manuel Gomes & Richard Grieve & Richard Nixon & Edmond S.‐W. Ng & James Carpenter & Simon G. Thompson, 2012. "Methods For Covariate Adjustment In Cost‐Effectiveness Analysis That Use Cluster Randomised Trials," Health Economics, John Wiley & Sons, Ltd., vol. 21(9), pages 1101-1118, September.
    2. Edmond S.-W. Ng & Richard Grieve & James R. Carpenter, 2013. "Two-stage nonparametric bootstrap sampling with shrinkage correction for clustered data," Stata Journal, StataCorp LLC, vol. 13(1), pages 141-164, March.
    3. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884, Decembrie.
    4. Sónia Romano & Débora Figueira & Inês Teixeira & Julian Perelman, 2022. "Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations," PharmacoEconomics, Springer, vol. 40(3), pages 269-295, March.
    5. Paola Salari & Cian O’Mahony & Séverine Henrard & Paco Welsing & Arjun Bhadhuri & Nadine Schur & Marie Roumet & Shanthi Beglinger & Thomas Beck & Katharina Tabea Jungo & Stephen Byrne & Stefanie Hossm, 2022. "Cost-effectiveness of a structured medication review approach for multimorbid older adults: Within-trial analysis of the OPERAM study," PLOS ONE, Public Library of Science, vol. 17(4), pages 1-17, April.
    6. Thompson, Simon G. & Nixon, Richard M. & Grieve, Richard, 2006. "Addressing the issues that arise in analysing multicentre cost data, with application to a multinational study," Journal of Health Economics, Elsevier, vol. 25(6), pages 1015-1028, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Victoria K. Brennan & Georgina Jones & Stephen Radley & Simon Dixon, 2021. "Incorporating Process Utility into Cost-Effectiveness Analysis via a Bolt-On Domain to the SF-6D: An Exploratory Study," Applied Health Economics and Health Policy, Springer, vol. 19(5), pages 747-756, September.
    2. Jungo, Katharina Tabea & Salari, Paola & Meier, Rahel & Bagattini, Michael & Spruit, Marco & Rodondi, Nicolas & Streit, Sven & Schwenkglenks, Matthias, 2024. "Cost-effectiveness of a medication review intervention for general practitioners and their multimorbid older patients with polypharmacy," Socio-Economic Planning Sciences, Elsevier, vol. 92(C).
    3. Manju, Md Abu & Candel, Math J.J.M. & van Breukelen, Gerard J.P., 2021. "Robustness of cost-effectiveness analyses of cluster randomized trials assuming bivariate normality against skewed cost data," Computational Statistics & Data Analysis, Elsevier, vol. 157(C).
    4. Chiranjeev Sanyal & Don Husereau, 2020. "Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 375-392, June.
    5. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    6. Julie A. Campbell & Glen J. Henson & Valery Fuh Ngwa & Hasnat Ahmad & Bruce V. Taylor & Ingrid Mei & Andrew J. Palmer, 2025. "Estimation of Transition Probabilities from a Large Cohort (> 6000) of Australians Living with Multiple Sclerosis (MS) for Changing Disability Severity Classifications, MS Phenotype, and Disease-Modif," PharmacoEconomics, Springer, vol. 43(2), pages 223-239, February.
    7. Christopher M Doran & Irina Kinchin, 2020. "Economic and epidemiological impact of youth suicide in countries with the highest human development index," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-11, May.
    8. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    9. Dongzhe Hong & Lei Si & Minghuan Jiang & Hui Shao & Wai-kit Ming & Yingnan Zhao & Yan Li & Lizheng Shi, 2019. "Cost Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: A Systematic Review," PharmacoEconomics, Springer, vol. 37(6), pages 777-818, June.
    10. Simon Pol & Paula Rojas Garcia & Fernando Antoñanzas Villar & Maarten J. Postma & Antoinette D. I. Asselt, 2021. "Health-Economic Analyses of Diagnostics: Guidance on Design and Reporting," PharmacoEconomics, Springer, vol. 39(12), pages 1355-1363, December.
    11. Paul Revill & Simon Walker & Valentina Cambiano & Andrew Phillips & Mark J Sculpher, 2018. "Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.
    12. Omar B. Da'ar & Abdi A. Gele, 2023. "Tuberculosis in a weak health system, conflict and fragile zone: The monetary value of human lives lost associated with deaths of persons older than 14 years in Somalia," International Journal of Health Planning and Management, Wiley Blackwell, vol. 38(1), pages 53-68, January.
    13. Anna Nicolet & Antoinette D I van Asselt & Karin M Vermeulen & Paul F M Krabbe, 2020. "Value judgment of new medical treatments: Societal and patient perspectives to inform priority setting in The Netherlands," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-18, July.
    14. McNamara, Simon & Tsuchiya, Aki & Holmes, John, 2021. "Does the UK-public's aversion to inequalities in health differ by group-labelling and health-gain type? A choice-experiment," Social Science & Medicine, Elsevier, vol. 269(C).
    15. Nikolai Mühlberger & Gaby Sroczynski & Artemisa Gogollari & Beate Jahn & Nora Pashayan & Ewout Steyerberg & Martin Widschwendter & Uwe Siebert, 2021. "Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(8), pages 1311-1344, November.
    16. Zachary Tirrell & Alicia Norman & Martin Hoyle & Sean Lybrand & Bonny Parkinson, 2024. "Bring Out Your Dead: A Review of the Cost Minimisation Approach in Health Technology Assessment Submissions to the Australian Pharmaceutical Benefits Advisory Committee," PharmacoEconomics, Springer, vol. 42(11), pages 1287-1300, November.
    17. Yasuhiro Hagiwara & Takeru Shiroiwa, 2022. "Estimating Value-Based Price and Quantifying Uncertainty around It in Health Technology Assessment: Frequentist and Bayesian Approaches," Medical Decision Making, , vol. 42(5), pages 672-683, July.
    18. Cameron Morgan & Cam Donaldson & Emily Lancsar & Stavros Petrou & Lazaros Andronis, 2024. "Considerations Around the Inclusion of Children and Young People’s Time in Economic Evaluation: Findings from an International Delphi Study," PharmacoEconomics, Springer, vol. 42(11), pages 1267-1277, November.
    19. Dina Jankovic & Pedro Saramago Goncalves & Lina Gega & David Marshall & Kath Wright & Meena Hafidh & Rachel Churchill & Laura Bojke, 2022. "Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis," PharmacoEconomics - Open, Springer, vol. 6(3), pages 377-388, May.
    20. Boshen Jiao & Zafar Zafari & Brian Will & Kai Ruggeri & Shukai Li & Peter Muennig, 2017. "The Cost-Effectiveness of Lowering Permissible Noise Levels Around U.S. Airports," IJERPH, MDPI, vol. 14(12), pages 1-10, December.

    More about this item

    Keywords

    Multimorbidity; Deprescribing; Cost effectiveness;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:26:y:2025:i:3:d:10.1007_s10198-024-01718-7. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.