Objectives The medicines bill in high income countries accounts for approximately 17% of total healthcare expenditure. However, around $500 million could be saved a year worldwide by optimising medicines use. This study aims to scope the evidence on the effectiveness and cost-effectiveness of interventions to address suboptimal use of medicines and pinpoint the evidence gaps to prioritise future research. Methods Systematic searches (up to February 2013) of the NHS Economic Evaluation Database, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects for systematic reviews on effectiveness or cost-effectiveness and for primary research on cost-effectiveness of interventions. Studies in English set in any country were included. Results Of the 646 records found, 108 studies met the inclusion criteria (29 cost-effectiveness studies (CES) and 81 systematic reviews on effectiveness (SRE)). The majority of CES addressed adherence (55%), followed by inappropriate prescribing (31%) and prescribing errors (28%). No studies addressed the full medicines pathway. A similar picture emerged for SRE at 67%, 15 and 11 respectively. Among the 15 types of outcomes used in CES, the top three were clinical (31%) measures of adherence (21%) and quality-adjusted life years (17%). In SRE, hospitalisations (43%), measures of adherence (23%) and mortality (21%) were the most frequent. Conclusions Interventions to improve suboptimal use of medicines tend to be specific to a particular aspect of the pathway and/or to a particular disease area. Little consideration is made on how to improve medicines use in patients with co-morbidities and poly-medication. The medicines pathway is rarely examined holistically but in a fragmented manner, making it difficult to draw conclusions on which aspect of suboptimal use of medicines should be prioritised for investment.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)