Cost-consequence analysis of self-administration of medication during hospitalization: a pragmatic randomized controlled trial in a Danish hospital setting

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Objectives:
The objective of this study was to evaluate the costs and consequences of introducing "self-administration of medication" (SAM) during hospitalization as compared with nurse-led dispensing and administration of medication.
Methods:
This pragmatic randomized controlled trial was performed in a Danish Cardiology Unit. Patients ⩾18 years old capable of self-administering medication were eligible. In the intervention group, patients self-administered their medication. In the control group, medication was dispensed and administered by nurses. The implementation of SAM was used to evaluate the cost–consequences. The micro-costing analysis used the hospital perspective and a short-term incremental costing approach. The costs for medication, materials, and nursing time were included. Consequences included the dispensing error proportion, patients’ perceptions regarding medication, satisfaction, and deviations in the medication list at followup. In addition, the number of readmissions and general practitioner (GP) contacts within 30 days after discharge was included.
Results:
The total cost (TC) per patient in the intervention group was 49.9€ (95% CI: 46.6–53.2) compared with 52.6€ (95% CI: 46.6–58.6) in the control group. The difference between the groups was not statistically significant (p = 0.09). Sensitivity analysis consistently showed TCs favoring the intervention. The dispensing error proportion was 9.7% (95% CI: 7.9–11.6) in the intervention group compared with 12.8% (95% CI: 10.9–15.6) in the control group. The difference was statistically significant (p = 0.02). The analysis also found changes in the perceptions regarding medication (indicating higher medication adherence), increased satisfaction, and fewer patients with deviations in the medication list at follow-up. No statistically significant differences between the groups in relation to readmissions and GP contacts within 30 days were observed.
Conclusions: SAM seems to cost less although the cost difference was small and not statistically significant. As SAM had positive effects on patient outcomes, the results indicate that SAM may be cost-effective.
Bidragets oversatte titelOmkostnings-konsekvens analyse af selvadministration af medicin under indlæggelse: et pragmatisk randomiseret kontrolleret studie
OriginalsprogEngelsk
TidsskriftTherapeutic Advances in Drug Safety
Vol/bind11
NummerJanuary-December
Sider (fra-til)1-16
Antal sider16
ISSN2042-0986
DOI
StatusUdgivet - jan. 2020

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