We recently showed that a pharmacist-led information technology-based intervention (PINCER) was significantly more effective in reducing medication errors in general practices than providing simple feedback on errors, with cost per error avoided at A 79 pound (US$131). We aimed to estimate cost effectiveness of the PINCER intervention by combining effectiveness in error reduction and intervention costs with the effect of the individual errors on patient outcomes and healthcare costs, to estimate the effect on costs and QALYs.
We developed Markov models for each of six medication errors targeted by PINCER. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. A composite probabilistic model combined patient-level error models with practice-level error rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated from the perspective of NHS England, with a 5-year time horizon.
The PINCER intervention generated A 2,679 pound less cost and 0.81 more QALYs per practice [incremental cost-effectiveness ratio (ICER): -A 3,037 pound per QALY] in the deterministic analysis. In the probabilistic analysis, PINCER generated 0.001 extra QALYs per practice compared with simple feedback, at A 4.20 pound less per practice. Despite this extremely small set of differences in costs and outcomes, PINCER dominated simple feedback with a mean ICER of -A 3,936 pound (standard error A 2,970) pound. At a ceiling 'willingness-to-pay' of A 20,000 pound/QALY, PINCER reaches 59 % probability of being cost effective.
PINCER produced marginal health gain at slightly reduced overall cost. Results are uncertain due to the poor quality of data to inform the effect of avoiding errors.
- NONSTEROIDAL ANTIINFLAMMATORY DRUGS
- EFFECTIVENESS ACCEPTABILITY CURVES
- AMIODARONE-INDUCED THYROTOXICOSIS
- VENTRICULAR DYSFUNCTION SOLVD
- CONVERTING ENZYME-INHIBITORS
- RANDOMIZED CONTROLLED-TRIAL
- BIPOLAR AFFECTIVE-DISORDER