Jeroen van de Pol

91 4 Cost-utility and cost-effectiveness analysis of a clinical medication review issues) of the drugs in use. Subsequently the pharmacist discussed the personal goals, preferences and other DRPs with the GP during a personal conversation. Recommendations were proposed in a pharmaceutical care plan, which was then discussed with the patient. Actions that both the patient, GP and pharmacist agreed upon were implemented gradually and two follow-up moments were scheduled (within approximately three months) to evaluate the attainment of goals and the agreed upon actions. The pharmaceutical care plan was adjusted when needed. Patients in the control group received usual care and were scheduled to receive a CMR after the study had finished (postponed intervention). Effects The primary outcome measures in the DREAMeR study were HR-QoL and the number of health-related complaints per patient with moderate to severe impact on the patient's daily life. Health-related quality of life was measured with the Dutch version of the EQ-5D-5 L and EQ-VAS [24]. These outcome measures were collected through written questionnaires at baseline, 3 months and 6 months. Questionnaires were sent to patients by the pharmacists, but completed independently by the patients. If in need of assistance, patients could obtain help from an independent research assistant. All questionnaires were recorded in duplicate by two independent research assistants to enable checks on registration mistakes. The EQ-5D-5L describes health status in terms of five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Scores on these five domains were used to estimate health utility values with the use of the Dutch EQ-5D-5L tariff, which ranges from − 0.329 (less than death) to 1 (indicating best possible health status) [25]. In addition, the EQ-VAS was used to measure a person's health status with scores ranging from 0–100, in which 0 indicates the worst and 100 indicates the best possible health status. In this economic analysis, the effects were determined with QALYs. The QALYs were calculated with the health utility values from the EQ-5D-5 L and EQ-VAS using linear interpolation between time points. Within the time horizon of the study (6 months), the maximum number of QALYs that a patient could gain was 0.5. Health-related complaints Health-related complaints were measured with a written questionnaire [23] and were basedon themost common complaints inolder people and themost common side effects of drugs [23,26]. Twelve complaints, e.g. pain, dizziness and stomach problems, were registered. The severity of these complaints was measured on a visual analogue scale (VAS), with a range from 0 to 10, and influence on a patient's daily life with a 5-point Likert scale. To add clinical relevance, a health-related