The selection of the comparators was appropriate as the proposed intervention was compared against the normal care in nursing homes, which did not include a pharmacist intervention.
The clinical evidence was appropriately derived from a RCT and its robust design should have ensured the validity of these data. The RCT was pragmatic, which ensured a detailed collection of data for the economic evaluation. It was published in a companion paper (Patterson, et al. 2010, see ‘Other Publications of Related Interest’ below for bibliographic details); limited information on its methods and results was presented in this article. The trial groups were comparable at baseline, except for their settings, with significantly more intervention homes in rural settings and more control homes in urban settings. The authors noted that the assessment of health-related quality of life was not possible in the older population with co-morbidities and a cost-utility analysis was not carried out. The benefit measure was specific to the intervention and might not be comparable with the benefits of other health care interventions.
The economic analysis was satisfactorily carried out and presented. The authors reported the details of the unit costs, resource quantities, price year, currency conversion, and data sources, which were commonly used databases in the UK. The use of a pragmatic trial ensured appropriate collection of resource use data representative of the authors’ setting. The costs were varied in the sensitivity analysis.
Analysis and results:
The results were clearly presented, especially the costs. An incremental approach was used to synthesise the costs and benefits of the two interventions. An appropriate multivariate approach was used to investigate uncertainty. The authors acknowledged some potential limitations of their analysis, such as the use of a per-protocol instead of an intention-to-treat approach in the RCT, and the impossibility of estimating the cost per fall avoided, which would have been a more relevant outcome for these patients. The analysis appears to have been specific to the authors’ setting and might not be transferable to other locations.
The economic evaluation was carried out alongside a pragmatic RCT and its clear and robust methods should have ensured the validity of the authors’ conclusions.