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Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital

BMJ open, 2013-01, Vol.3 (1), p.e001563 [Peer Reviewed Journal]

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2013 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2013 ;ISSN: 2044-6055 ;EISSN: 2044-6055 ;DOI: 10.1136/bmjopen-2012-001563 ;PMID: 23315436

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  • Title:
    Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital
  • Author: Ghatnekar, Ola ; Bondesson, Åsa ; Persson, Ulf ; Eriksson, Tommy
  • Subjects: Basic Medicine ; Clinical Medicine ; Clinical outcomes ; Cost control ; Decision trees ; Drug stores ; Farmakologi och toxikologi ; Health care expenditures ; Health Economics ; Hospital costs ; Hospitalization ; Intervention ; Klinisk medicin ; Läkemedelskemi ; Medical and Health Sciences ; Medical errors ; Medicin och hälsovetenskap ; Medicinal Chemistry ; Medicinska och farmaceutiska grundvetenskaper ; Neurologi ; Neurology ; Nurses ; Nursing homes ; Patient admissions ; Pharmacists ; Pharmacology and Toxicology ; Primary care ; Probability ; Quality of life ; Reconciliation
  • Is Part Of: BMJ open, 2013-01, Vol.3 (1), p.e001563
  • Description: Objective To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits. Method Published data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature. Results The total cost for the LIMM model was €290 compared to €630 for standard care, in spite of a €39 intervention cost. The main cost offset arose from avoided drug-related readmissions in the Admission part (€262) whereas only €66 was offset in the Discharge part as a result of fewer outpatient visits and correction time. The reduced disutility was estimated to 0.005 quality-adjusted life-years (QALY), indicating that LIMM was a dominant alternative. The probability that the intervention would be cost-effective at a zero willingness to pay for a gained QALY compared to standard care was estimated to 98%. Conclusions The LIMM medication reconciliation (at admission and discharge) and medication review was both cost-saving and generated greater utility compared to standard care, foremost owing to avoided drug-related hospital readmissions. When implementing such a review process with a multidisciplinary team, it may be important to consider a learning curve in order to capture the full advantage.
  • Publisher: England: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 2044-6055
    EISSN: 2044-6055
    DOI: 10.1136/bmjopen-2012-001563
    PMID: 23315436
  • Source: ProQuest One Psychology
    BMJ Open Access Journals
    Geneva Foundation Free Medical Journals at publisher websites
    PubMed Central
    SWEPUB Freely available online
    ROAD: Directory of Open Access Scholarly Resources
    ProQuest Central
    DOAJ Directory of Open Access Journals
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