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

Paddy Gillespie (), Frank Moriarty, Susan M. Smith, Anna Hobbins, Sharon Walsh, Barbara Clyne, Fiona Boland, Tara McEnteggart, Michelle Flood, Emma Wallace and Caroline McCarthy
Additional contact information
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

The European Journal of Health Economics, 2025, vol. 26, issue 3, No 7, 427-454

Abstract: 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.

Keywords: Multimorbidity; Deprescribing; Cost effectiveness (search for similar items in EconPapers)
JEL-codes: I10 I11 (search for similar items in EconPapers)
Date: 2025
References: Add references at CitEc
Citations:

Downloads: (external link)
http://link.springer.com/10.1007/s10198-024-01718-7 Abstract (text/html)
Access to the full text of the articles in this series is restricted.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:eujhec:v:26:y:2025:i:3:d:10.1007_s10198-024-01718-7

Ordering information: This journal article can be ordered from
http://www.springer. ... cs/journal/10198/PS2

DOI: 10.1007/s10198-024-01718-7

Access Statistics for this article

The European Journal of Health Economics is currently edited by J.-M.G.v.d. Schulenburg

More articles in The European Journal of Health Economics from Springer, Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ) Contact information at EDIRC.
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().