Jeroen van de Pol

88 Chapter 4 Abstract Aims The ageing society may lead to increasing healthcare expenditure. A clinical medication review (CMR) could potentially reduce costs. The aim of this study is to perform a cost-utility and cost effectiveness analysis from a societal perspective of a patient-centered CMR. Methods A trial-based cost-utility and cost-effectiveness analysis was performed as part of the DREAMeR study, a pragmatic controlled trial that randomized patients aged ≥ 70 years using at least seven drugs to either CMR or usual care. Over six months, healthcare consumption and drug use were collected to estimate costs, and effects were collected in terms of quality-adjusted life years (QALYs) measured with EQ-5D-5 L and EQ-VAS and as reduced health-related complaints with impact on patients' daily lives. Results The total mean costs per patient (n = 588) over six months were €4,189 ± 6,596 for the control group (n = 294) and €4,008 ± 6,678 for the intervention group (n = 294), including estimated intervention costs of €199 ± 67, which resulted in a mean incremental total cost savings of €181 for the intervention group compared to the control group. Compared to the control group, for the intervention group, the mean incremental QALYs over six months were: − 0.00217 measured with EQ- 5D and 0.003 measured with EQ-VAS. The incremental effect of reduced health related complaints with impact was − 0.34. There was a likelihood of > 90% that the intervention was cost-saving. Conclusions The benefits of a patient-centered CMR were inconsistent with no benefits on HR- QoL measured with EQ-5D-5 L and small benefits on HR-QoL measured with EQ- VAS and health-related complaints with impact on patients' daily lives. Additionally, a CMR could potentially be cost saving from a societal perspective.