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Reducing Potentially Inappropriate Prescribing For Older People In Primary Care In Ireland: A Trial-Based Economic Evaluation Of The OPTI-SCRIPT Intervention
Potentially inappropriate prescribing describes suboptimal prescribing practices that increase the risk of adverse drug events for patients in circumstances where safer, more effective treatment alternatives are available for the condition of interest. This study examines the cost effectiveness of an intervention to reduce potentially inappropriate prescribing for older patients in Ireland. An economic evaluation, employing cost effectiveness analysis and cost utility analysis, was conducted alongside a cluster randomised controlled trial of 21 general practices and 196 patients, to compare the multifaceted OPTI-SCRIPT intervention to usual practice in primary care. Incremental costs, potentially inappropriate prescriptions (PIPs), and quality adjusted life years (QALYs) at 12 months follow up were estimated using multilevel regression and uncertainty was explored using cost effectiveness acceptability curves. The intervention was associated with a non-significant mean cost increase of €407 (95% CIs: -357, 1170), a significant mean reduction in PIPs of 0.379 (95% CI: 0.092, 0.666), and a non-significant mean increase in QALYs of 0.013 (95% CIs: -0.016, 0.042). While there was evidence that the OPTI-SCRIPT intervention may be cost effective if decision makers are willing to pay at least €1,269 per PIP avoided, the evidence was weaker if effectiveness was measured in terms of QALYs gained. Further studies are required to explore the health and economic implications of interventions targeting potentially inappropriate prescribing.