Jeroen van de Pol

97 4 Cost-utility and cost-effectiveness analysis of a clinical medication review Table 3: Incremental effects and costs between control and intervention group over six months. Costs are presented as mean cost per patient ± standard deviation. Abbreviations: QALY = quality-adjusted life years, EQ=EuroQol, VAS = visual analogue scale. Type of effects and costs Control group (n=294) Intervention group (n=294) Incremental effects or costs Effects QALYs (EQ-5D) 0.369 (0.355-0.377) 0.367 (0.345-0.370) -0.00217 QALYs (EQ-VAS) 0.345 (0.332-0.356) 0.348 (0.335-0.362) 0.003 Reduced health-related complaints with impact 0.04 0.38 -0.34 Healthcare costs Drugs € 873 ± 822 833 ± 888 € -40 Healthcare resources Primary care € 414 ± 558 € 346 ± 453 € -68 Secondary care € 755 ± 1,925 € 700 ± 1,997 € -55 Institutional care € 475 ± 3,507 € 311 ± 3,655 € -164 Home care € 1,198 ± 2,821 € 1,296 ± 2,923 € 97 Informal care € 474 ± 2,126 € 323 ± 1,542 € -150 Total healthcare costs € 4,189 ± 6,596 € 3,809 ± 6,678 € -380 Intervention costs Clinical medication review n.a. €199 ± 67 € 199 Total costs € 4,189 ± 6,596 € 4,008 ± 6,687 € -181 Probabilistic sensitivity analysis Regarding the results from the cost-utility analysis, the CMR emerged as the dominant strategy for the EQ-VAS and health-related complaints with impact. Based on 1,000 multiple replications, probabilistic sensitivity analyses (PSA) were performed and are presented in Figure 2. Figure 2A illustrates the ICER for costs/ QALY measured with EQ-5D. Most of the simulations are located in the lower-left quadrant (59.9%) and in the lower-right quadrant (33.7%) of the cost-effectiveness plane, which results in a probability of 93.6% that a CMR is cost-saving and a probability of 63.7% of QALY loss. Figure 2B presents the ICER for costs/QALY measured with EQ-VAS; most of the simulations are located in the lower-right quadrant (69.2%) and in the lower-left quadrant (24.4%) of the cost effectiveness plane, which results in a chance of 93.6% that a CMR is cost saving and a 26.1% of QALY loss (Figure 2B). Figure 2C offers the ICER for costs/reduced complaint