Cost avoidance of pharmacist-led deprescribing using STOPPFrail for older adults in nursing homes

Abstract

Abstract Background: The Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria aim to reduce inappropriate or unnecessary medications in frail older adults, which should minimise adverse drug events and additional healthcare expenditure. Little is known about the economic outcomes of applying these criteria as an intervention. Aim: To evaluate cost avoidance associated with pharmacist-led application of STOPPFrail to frail older nursing home residents. Method: Pharmacist-identified STOPPFrail-defined PIMs that were deprescribed by patients’ general practitioners were assigned a rating by a multidisciplinary panel, i.e. the probability of an adverse drug event occurring if the PIM was not deprescribed. The intervention’s net cost benefit and cost-benefit ratio were then determined by factoring in ADE cost avoidance (calculated from pADE ratings), direct cost savings (deprescribed medication costs and reimbursement fees), and healthcare professionals’ salaries. Results: Of the 176 PIMs deprescribed across 69 patients, 65 PIMs (36.9%) were rated as having a medium or high probability of an adverse drug event occurring if not deprescribed. With €27,162 for direct cost savings, €61,336 for ADE cost avoidance, and €2,589 for healthcare professionals' salary costs, there was a net cost benefit of €85,909 overall. The cost-benefit ratio was 33.2:1 and remained positive in all scenarios in sensitivity analyses. Conclusion: Pharmacist-led application of STOPPFrail to frail older nursing home residents is associated with significant cost avoidance. Wider implementation of pharmacist interventions in frail older nursing home residents should be considered to reduce PIMs and patient harm, alongside substantial cost savings for healthcare systems.