Date Published:October 2016
OBJECTIVES: Medication discrepancies at the time of
hospital discharge are common and can harm patients.
Medication reconciliation by pharmacists has been shown
to prevent such discrepancies and the adverse drug events
(ADEs) that can result from them. Our objective was to
estimate the economic value of nontargeted and targeted
medication reconciliation conducted by pharmacists and
pharmacy technicians at hospital discharge versus usual care.
STUDY DESIGN: Discrete-event simulation model.
METHODS: We developed a discrete-event simulation
model to prospectively model the incidence of drug-related
events from a hospital payer’s perspective. The model
assumptions were based on data published in the peerreviewed
literature. Incidences of medication discrepancies,
preventable ADEs, emergency department visits,
rehospitalizations, costs, and net benefit were estimated.
RESULTS: The expected total cost of preventable ADEs was
estimated to be $472 (95% credible interval [CI], $247-$778)
per patient with usual care. Under the base-case assumption
that medication reconciliation could reduce medication
discrepancies by 52%, the cost of preventable ADEs could
be reduced to $266 (95% CI, $150-$423), resulting in a
net benefit of $206 (95% CI, $73-$373) per patient, after
accounting for intervention costs. A medication reconciliation
intervention that reduces medication discrepancies by
at least 10% could cover the initial cost of intervention.
Targeting medication reconciliation to high-risk individuals
would achieve a higher net benefit than a nontargeted
intervention only if the sensitivity and specificity of a
screening tool were at least 90% and 70%, respectively.
CONCLUSIONS: Our study suggests that implementing a
pharmacist-led medication reconciliation intervention at hospital
discharge could be cost saving compared with usual care.