Jeroen van de Pol

92 Chapter 4 complaint with moderate to severe impact on patient's daily life was defined as the following: a severity score with VAS ≥ 5 and influence on daily life of moderate, severe or extreme ( ≥ 3 points on a 5-point Likert scale) [27]. Effectiveness was determined as the number of reduced health-related complaints with impact per patient 6 months after the study period. Costs Identification This study evaluated costs from a societal perspective. Healthcare costs were divided into direct costs and indirect costs. Direct healthcare costs included healthcare consumption and drug costs measured in the RCT. Indirect healthcare costs included informal care maximized to 16 hours per day. Productivity costs were not included given that all patients were expected to be retired as they are all older than 70 years. Measurement Healthcare consumption was measured with the Dutch Medical Consumption (iMTA) Questionnaire including an extra question about informal care through telephone assessments performed by independent study assistants at baseline and 3 and 6 months after the start date [28]. Data were collected at each time point about the previous 3 months. Total healthcare costs were divided into six different categories: (1) drugs; (2) primary care, including GP, practice nurse, physiotherapist and other visits; (3) secondary care, including emergency department visits, hospital admissions and visits to physicians at outpatient clinics; (4) institutional care, including day visits and admissions to rehabilitation clinics, psychiatric wards and nursing homes; (5) home care, including housekeeping and nursing; and (6) informal care. Informal care was measured by asking patients the amount of time they had received informal care for the past 3 months. Drug dispensing records were collected from the pharmacy information systems to calculate drug costs during the study period of 6 months. To measure the time spent for the CMR, all pharmacists were asked to record the average time spent for every step of the medication review process, including patient interview, DRP analysis, conversation with GP and follow-up and monitoring. In addition, the time spent by the pharmacy technician during the CMR process was recorded.