Health economic evaluation of a medication safety intervention in elderly care: identifying causal effects in a multi-center quasi-experimental study design

The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real...

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Published in:	BMC health services research Vol. 25; no. 1; pp. 773 - 15
Main Authors:	Langenberger, Benedikt, Siegel, Martin, Busse, Reinhard, Vogt, Verena
Format:	Journal Article
Language:	English
Published:	London BioMed Central 30.05.2025 BioMed Central Ltd Springer Nature B.V BMC
Subjects:	Adverse and side effects Aged Aged patients Aged, 80 and over Ambulatory care Comorbidity Cost-Benefit Analysis Drug therapy Drug-Related Side Effects and Adverse Reactions - economics Drug-Related Side Effects and Adverse Reactions - prevention & control Drugs Economic aspects Evaluation Female Geriatrics Germany Health Administration Health Informatics Hospital care Hospitalization - economics Hospitalization - statistics & numerical data Hospitals Humans Interdisciplinary aspects Intervention Male Medical care, Cost of Medicine Medicine & Public Health Multimorbidity Nursing care Nursing homes Nursing Research Older people Participation Patient admissions Polypharmacy Propensity Score Public Health Reimbursement Statistics Germany
ISSN:	1472-6963, 1472-6963
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Abstract	The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real-world conditions, thereby providing a pragmatic approach to the challenges of multi-center studies with staggered intervention starts and voluntary participation. The analysis utilizes iterative Propensity Score Matching (PSM) followed by a Difference-in-Differences (DiD) estimator to navigate the methodological complexities and assess the intervention’s effectiveness and cost-effectiveness. Results reveal a significant reduction in ADE-related hospital admissions by 27.5% and overall hospital admissions by 17.5%. We find that the intervention is cost-effective at an incremental cost-effectiveness ratio (ICER) of €15,169.66 per averted ADE and €4,180.61 per averted hospital admission. This study illustrates for evaluating complex health interventions in real-world settings and underscores the importance of balancing health outcomes improvements with economic considerations in aging populations.
AbstractList	The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real-world conditions, thereby providing a pragmatic approach to the challenges of multi-center studies with staggered intervention starts and voluntary participation. The analysis utilizes iterative Propensity Score Matching (PSM) followed by a Difference-in-Differences (DiD) estimator to navigate the methodological complexities and assess the intervention's effectiveness and cost-effectiveness. Results reveal a significant reduction in ADE-related hospital admissions by 27.5% and overall hospital admissions by 17.5%. We find that the intervention is cost-effective at an incremental cost-effectiveness ratio (ICER) of €15,169.66 per averted ADE and €4,180.61 per averted hospital admission. This study illustrates for evaluating complex health interventions in real-world settings and underscores the importance of balancing health outcomes improvements with economic considerations in aging populations. Abstract The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real-world conditions, thereby providing a pragmatic approach to the challenges of multi-center studies with staggered intervention starts and voluntary participation. The analysis utilizes iterative Propensity Score Matching (PSM) followed by a Difference-in-Differences (DiD) estimator to navigate the methodological complexities and assess the intervention’s effectiveness and cost-effectiveness. Results reveal a significant reduction in ADE-related hospital admissions by 27.5% and overall hospital admissions by 17.5%. We find that the intervention is cost-effective at an incremental cost-effectiveness ratio (ICER) of €15,169.66 per averted ADE and €4,180.61 per averted hospital admission. This study illustrates for evaluating complex health interventions in real-world settings and underscores the importance of balancing health outcomes improvements with economic considerations in aging populations. The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real-world conditions, thereby providing a pragmatic approach to the challenges of multi-center studies with staggered intervention starts and voluntary participation. The analysis utilizes iterative Propensity Score Matching (PSM) followed by a Difference-in-Differences (DiD) estimator to navigate the methodological complexities and assess the intervention's effectiveness and cost-effectiveness. Results reveal a significant reduction in ADE-related hospital admissions by 27.5% and overall hospital admissions by 17.5%. We find that the intervention is cost-effective at an incremental cost-effectiveness ratio (ICER) of [euro]15,169.66 per averted ADE and [euro]4,180.61 per averted hospital admission. This study illustrates for evaluating complex health interventions in real-world settings and underscores the importance of balancing health outcomes improvements with economic considerations in aging populations. The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real-world conditions, thereby providing a pragmatic approach to the challenges of multi-center studies with staggered intervention starts and voluntary participation. The analysis utilizes iterative Propensity Score Matching (PSM) followed by a Difference-in-Differences (DiD) estimator to navigate the methodological complexities and assess the intervention's effectiveness and cost-effectiveness. Results reveal a significant reduction in ADE-related hospital admissions by 27.5% and overall hospital admissions by 17.5%. We find that the intervention is cost-effective at an incremental cost-effectiveness ratio (ICER) of €15,169.66 per averted ADE and €4,180.61 per averted hospital admission. This study illustrates for evaluating complex health interventions in real-world settings and underscores the importance of balancing health outcomes improvements with economic considerations in aging populations.The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real-world conditions, thereby providing a pragmatic approach to the challenges of multi-center studies with staggered intervention starts and voluntary participation. The analysis utilizes iterative Propensity Score Matching (PSM) followed by a Difference-in-Differences (DiD) estimator to navigate the methodological complexities and assess the intervention's effectiveness and cost-effectiveness. Results reveal a significant reduction in ADE-related hospital admissions by 27.5% and overall hospital admissions by 17.5%. We find that the intervention is cost-effective at an incremental cost-effectiveness ratio (ICER) of €15,169.66 per averted ADE and €4,180.61 per averted hospital admission. This study illustrates for evaluating complex health interventions in real-world settings and underscores the importance of balancing health outcomes improvements with economic considerations in aging populations.
ArticleNumber	773
Audience	Academic
Author	Langenberger, Benedikt Busse, Reinhard Vogt, Verena Siegel, Martin
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Snippet	The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and... Abstract The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events...
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SubjectTerms	Adverse and side effects Aged Aged patients Aged, 80 and over Ambulatory care Comorbidity Cost-Benefit Analysis Drug therapy Drug-Related Side Effects and Adverse Reactions - economics Drug-Related Side Effects and Adverse Reactions - prevention & control Drugs Economic aspects Evaluation Female Geriatrics Germany Health Administration Health Informatics Hospital care Hospitalization - economics Hospitalization - statistics & numerical data Hospitals Humans Interdisciplinary aspects Intervention Male Medical care, Cost of Medicine Medicine & Public Health Multimorbidity Nursing care Nursing homes Nursing Research Older people Participation Patient admissions Polypharmacy Propensity Score Public Health Reimbursement Statistics
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Title	Health economic evaluation of a medication safety intervention in elderly care: identifying causal effects in a multi-center quasi-experimental study design
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