Effect of med reconciliation on med cost after hospital D/C [article]

The Annals of Pharmacotherapy March 20121

BACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs.

OBJECTIVE: To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

METHODS: A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included.

RESULTS: Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10).

CONCLUSIONS: Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.

Based on the exchange rate mentioned in the study (EUR 1 = USD 1.3443) the six month savings associated with medication reconciliation was about $75 U.S. per patient after factoring in labor. Not exactly earth shattering, but nothing to turn your back on either. At least there’s a positive ROI.

I would have liked to have seen the authors take the study one step further by linking the medication reconciliation savings back to hospitalization readmission and/or effect on the patient’s lifestyle/activity. Once in a while optimizing a patient’s therapy might mean trading a more expensive drug for ease of use or improved patient compliance.

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  1. Karapinar-Çarkit F, Borgsteede SD, Zoer J, Egberts TC, van den Bemt PM, van Tulder M.Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. Ann Pharmacother. 2012 Mar;46(3):329-38. Epub 2012 Mar 6. PubMed PMID: 22395255.

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