Cost-effectiveness of a medication review intervention for general practitioners and their multimorbid older patients with polypharmacy.

Jungo, Katharina Tabea; Salari, Paola; Meier, Rahel; Bagattini, Michael; Spruit, Marco; Rodondi, Nicolas; Streit, Sven; Schwenkglenks, Matthias (2024). Cost-effectiveness of a medication review intervention for general practitioners and their multimorbid older patients with polypharmacy. Socio-Economic Planning Sciences, 92, p. 101837. Elsevier 10.1016/j.seps.2024.101837

Jungo_SocioEconPlannSci_2024.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (710kB) | Preview

Older adults with multiple chronic conditions and polypharmacy are at an increased risk of having adverse health outcomes, affecting quality of life and generating costs. Primary care has to be effective to guarantee excellent treatment to these patients, who are among the most vulnerable. This project aimed to assess the cost-effectiveness of a tool aimed at improving general practitioners' (GPs) performance, namely a medication review intervention centered around an electronic clinical decision support system (eCDSS). We performed a pre-planned within-trial cost-effectiveness analysis of the OPTICA trial, a cluster randomized controlled trial in Swiss primary care practices aimed at optimizing medication appropriateness and reducing prescribing omissions. Trial participants were older adults aged ≥65 years with ≥3 chronic conditions and ≥5 medications. The 160 participants in the intervention group received a medication review intervention centered around an eCDSS provided by their GP and followed by shared decision-making with their GP. The 163 participants in the control group had a medication discussion in line with usual care with their GP. Patients were followed-up for 12 months. Considering the clustered structure of the data at GP practice level, we applied Generalized Structural Equation Models (GSEMs) on a multiple imputed sample to estimate intervention effects on costs and quality-adjusted life years (QALYs). The intervention strategy was dominant with cost-savings of CHF 1′857 (95 % confidence interval (CI): CHF -3′620 to −93, p-value <0.039, with CHF 1≅USD 1.11 as of November 2023) and a gain of 0.026 incremental QALYs (95 % CI: 0.013 to 0.040, p-value <0.001) per study participant. In robustness analyses, directions of effects were fully consistent, albeit some effect estimates non-significant. Subgroup analyses suggested stronger effects in men and older adults aged 65–74 years or aged ≥85 years. The medication review intervention led to cost savings and an improvement in quality of life, potentially resulting from an accumulation of multiple small positive intervention effects, such as fewer hospitalizations and nursing visits at home.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Jungo, Katharina Tabea, Rodondi, Nicolas, Streit, Sven


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services






[4] Swiss National Science Foundation




Doris Kopp Heim

Date Deposited:

23 Feb 2024 16:36

Last Modified:

29 Feb 2024 12:18

Publisher DOI:


Additional Information:

Jungo and Salari share first authorship. Streit and Schwenkglenks share last authorship.




Actions (login required)

Edit item Edit item
Provide Feedback