Economic impact of undertaking reviews

Polypharmacy guidance: Appropriate prescribing making medicines safe, effective and sustainable 2026-2029
National

A systematic review found that interventions to optimise medication use have benefits that outweigh the costs. A narrative review on the impact of interventions to decrease polypharmacy found that economic benefits are important factors to consider.89 However, the scale up of such studies in this area are limited and need to address the barriers and enablers. The SIMPATHY project set out the key elements to scale up a program to address inappropriate polypharmacy and developed the economic modelling from the 2015 Polypharmacy guidance. The iSIMPATHY program has scaled these findings in three EU countries. A summary of the findings are given below and the detailed analysis can be found in the full evaluation report on the iSIMPATHY website. 

The analysis determined that, on average, per 100 reviews:

  • cost £7,500 (€8,786) to deliver
  • results in £13,100 (€15,346) direct savings associated with medication changes

Healthcare cost avoidance and patient benefits per 100 reviews:

  • theoretical projection of potential avoided admissions could be associated with £6,600 (€7,731) indirect savings from avoided adverse drug reaction-related hospital admissions (in-patient costs)
  • linking recorded Eadon scores to cost avoidance and quality adjusted life year (QALY) gains estimated an average of £168,800 (€197,800) in medical costs and a 7.4 QALY gain, using Eadon intervention classification calculations

The total cost reduction from net medication changes alone would more than outweigh the staff cost for the Republic of Ireland and Scotland. With either the bottom-up or top-down approaches to economic analysis, the benefits (cost avoidance) would outweigh the associated direct cost in all three regions.

If comprehensive medicine reviews were provided to all patients aged over 65 years (over 75 years in Northern Ireland), taking five or more medicines in each country the maximum avoidable inpatient cost would be £24.7 million (€28.9 million) for Ireland; £11.0 million (€12.9 million) for Northern Ireland; and £36.0 million (€42.1 million) for Scotland.

The iSIMPATHY model has been demonstrated to be generally applicable in a range of healthcare settings and in different healthcare systems. There has been interest both at European level and globally to adopt this methodology to address this public health challenge.90,91