The Pharmaceutical Journal
Vol 278 No 7437 p123
3 February 2007

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Health economists call for review of MUR service

Health economists who discovered that domiciliary medication review in elderly people when they were discharged from hospital resulted in increased rates of readmission (PJ, 22 January 2005, p71), now say that their findings mean that the medicines use review service introduced in the pharmacy contract should be reconsidered.

Using cost data from 2000, and involving patients over 80 years of age who had been discharged from hospital taking at least two medicines daily, the researchers say that the incremental cost of each extra year of life resulting from the reviews was £33,541. The cost per quality adjusted life year was £54,454. The paper, by Margaret Pacini and colleagues, is published in the February issue of Pharmacoeconomics (2007;25:171–80).

The authors conclude: “The current policy imperative for implementing medicines [use] review needs to be reconsidered in the light of the findings of this study: a small, non-significant gain in quality of life, no reduction in hospital admissions and a low probability of cost-effectiveness.”

An accompanying editorial by Arnold Zermansky, University of Leeds, and Nick Freemantle, University of Birmingham, says that the research adds another piece to a growing jigsaw of conflicting evidence about [any type of] medication review by pharmacists.

But they warn: “It is only when the papers are examined in detail that the apparent conflicts of outcome are seen for what they are — differences inherent in comparing different interventions that sound the same.”

They go on: “As things stand it would be impossible to aggregate data in a meta-analysis. We just don’t know whether pharmacist medication review does any good.”

One of the paper’s authors, Richard Holland, senior lecturer in public health at the University of East Anglia, said: “We are concerned given our trial findings of a non-significant effect on quality of life and mortality and increased admissions, that a lower level intervention such as MUR should be rigorously tested. It may be effective, ineffective or even harmful (by confusing patients or for other more complex reasons). If effective, it should also be demonstrably cost-effective.”