1. Int J Clin Pharm. 2011 Dec;33(6):909-17. Epub 2011 Oct 8.

Review of the cost-effectiveness of interventions to improve seamless care
focusing on medication.

Simoens S, Spinewine A, Foulon V, Paulus D.

Research Centre for Pharmaceutical Care and Pharmaco-economics, Katholieke,
Universiteit Leuven, Onderwijs en Navorsing 2, Herestraat 49, P.O. Box 521, 3000,
Leuven, Belgium. steven.simoens@pharm.kuleuven.be

AIM OF THE REVIEW: This review of the international literature aims to assess the
evidence and its methodological quality relating to the cost-effectiveness of
interventions to improve seamless care focusing on medication.
METHOD: Studies were identified by searching Medline, EMBASE, Centre for Reviews 
and Dissemination databases, Cochrane Database of Systematic Reviews, and EconLit
up to March 2011 using search terms related to health economics and to seamless
care. To be included, economic evaluations had to explore the costs and
consequences of an intervention to improve seamless care focusing on medication
as compared with usual care. Methodological quality of studies was assessed by
considering perspective; design; source of clinical and economic data; cost and
consequence measures; allowance for uncertainty; and incremental analysis. Costs 
were actualized to 2007 values.
RESULTS: Eight studies on medication interventions for hospitalized patients in
the transition between ambulatory and hospital care were included in the review. 
A variety of types of medication interventions and target populations have been
assessed, but the evidence is limited to one economic evaluation for each
particular intervention type and each specific target population. Most studies
demonstrated an impact of interventions on compliance and (re)hospitalization
rates and costs. The studies did not find an impact on quality of life or
symptoms. Economic evaluations suffered from methodological limitations related
to the narrow perspective; restriction to health care costs only; exclusion of
costs of the intervention; use of intermediate consequence measures; no allowance
for uncertainty; and absence of incremental analysis.
CONCLUSION: In light of the small number of economic evaluations and their
methodological limitations, it is not possible to recommend a specific
intervention to improve seamless care focusing on medication on health economic
grounds.

PMID: 21979148  [PubMed - indexed for MEDLINE]