Budget impact analysis of medication reviews by junior pharmacists in polypharmacy patients: a hospital perspective.

introductionPharmacist-led medication reviews are increasingly recognised for generating cost savings within the hospital. However, no cost-analysis has investigated the budget impact of junior pharmacists conducting medication reviews under supervision of clinical pharmacists, nor included recommendations to start-, increase-, or monitor medications.

aimTo assess the budget impact of medication reviews by supervised junior pharmacists across hospital wards, explore budget impact differences between drug classes, and identify patient predictors that potentially influence the budget impact.

methodData of medication reviews were collected over a 19-month period in patients with polypharmacy (≥ 5 medications) who had at least one additional risk factor. We developed a cost model over a one-year horizon, from the hospital perspective. Intervention costs were derived from measured labour time per medication review and salary of junior- and clinical pharmacists. Cost avoidance from potential preventable medication-related readmissions were based on admission time, admission costs and an estimate of preventable medication-related admissions (4.8%). Costs and savings from medication recommendations were aggregated using drug price per daily defined dose and its predicted days of therapy per year, and clustered by drug class. Scenario analyses tested the robustness of medication recommendation savings to account for effectively implemented and additional monitoring recommendations. Patient predictors of budget impact related to medication recommendations were assessed using multivariable linear regression, including age, gender, eGFR, acute admission, medication count, comorbidity, expensive drugs, and ward type.

resultsWe collected 271 medication reviews, including 1,689 medication recommendations. Per-patient budget impact was negative for the intervention (€104 costs), but positive for medication recommendations (€46 savings), and preventable medication-related readmissions (€239 savings). Total estimated savings were €181 per patient, and €688,000 when upscaled hospital-wide. Opiates, beta receptor agonists, corticosteroids, urological drugs, and muscarine receptor antagonists generated 43% of medication recommendation savings. Erythropoietic growth factors, SGLT2 inhibitors, etanercept, etravirine, and calcium/vitamin D formulations generated 70% of medication recommendation costs. No significant associations were found between any of the included patient characteristics and budget impact related to medication recommendations.

conclusionJunior pharmacist-led medication reviews provide a modest cost-saving intervention from the hospital perspective, demonstrating savings across clinical populations with polypharmacy.