The cost-effectiveness of a structured medication review in Parkinson's Disease

Introduction: Parkinson’s disease (PD) causes multiple motor and non-motor impairments. Most PD patients have complex medication regimens with multiple daily doses to control symptoms. A structured medication review (SMR) has shown to be valuable in improving therapy adherence and clinical outcomes in different care settings, but showed no significant improvement in quality of life in PD patients. The cost-effectiveness of an SMR in PD patients is yet still unknown. Therefore, the aim of this study is to determine the cost-effectiveness of performing an SMR in PD patients. Methods: A cost-effectiveness analysis was performed based on a multicenter randomized controlled trial with 202 PD patients with polypharmacy. The intervention group received an SMR executed by a community pharmacist, whereas the control arm received usual care. The primary outcome of this study is the cost-effectiveness of performing an SMR in PD. The effect of the intervention was presented as incremental Quality Adjusted Life Years (QALYs), measured using the EQ-5D-5L questionnaire. Costs were determined based on real data. Missing data was imputed using multiple imputations techniques. Bootstrapping was used to estimate the uncertainty in all health and economic outcomes. Results: The incremental QALYs of the intervention group compared to the control group was -0.008 (95%-CI -0.018 to 0.001) and incremental costs were €249 (95%-CI €-120 to €623). Bootstrapping showed that when adapting a willingness-to-pay threshold of €20,000/QALY and €80,000/QALY, the probability of SMRs being cost-effective was 9% and 12%, respectively. Conclusion: An SMR in PD patients in primary care executed by community pharmacists shows no apparent benefit and is not cost-effective compared to usual care.