Jeroen van de Pol

99 4 Cost-utility and cost-effectiveness analysis of a clinical medication review admissions) and the costs of institutional care had the highest impact on the uncertainty of the ICER, but the CMR still results in cost savings because the ranges of all variables are lower than the incremental costs of − €181. Figure 3: Tornado diagram which describes the effects of uncertainty for the different cost categories. Abbreviations: CG = control group, IG = intervention group. -200,00 -150,00 -100,00 -50,00 0,00 50,00 100,00 Primary care (average €) Informal care (average €) Home care (average €) Drugs (average €) Institutional care (average €) Clinical medication review (average €) Secondary care (average €) Figure 3: Tornado diagram which describes the effects of uncertainty for the different cost categories. Discussion This study shows that a CMR focusing on patient's preferences, goals and health- related complaints probably does not lead to an increase in costs from a societal perspective and could potentially be cost saving. The effect a CMR has on HR-QoL is less clear. HR-QoL measured with EQ-5D shows that a CMR could slightly reduce the quality of life. However, HR-QoL measured with EQ-VAS and health related complaints with impact on daily life shows a slight to moderate improvement by increasing the quality of life and reducing the number of complaints with impact on daily life. There is limited evidence for effects of CMR on clinical and economic outcomes [14,33–35]. The patient centered approach applied during CMR in this study improved relevant outcomes for older patient's lives based on the EQ-VAS and the number of health-related complaints with impact on patients' daily lives. This could possibly be explained by the patient-centered and goal-oriented character