| Resource-Utilization Outcome | Study Design: No. Studies (N Patients Analyzed) | Strength of Evidence | Supporting Judgment | Study Findings and Direction of Effect |
|---|---|---|---|---|
| Use of generics | Cohort: 1 (63,198 to 200,722) | Insufficient | High study limitations, consistency unknown, direct, imprecise | Odds range from -0.01 to 0.006. |
| Medication costs: patient copayments | RCT: 1 (NR) | Insufficient | Medium study limitations, consistency unknown, indirect, precision cannot be determined | Calculated mean difference, -64 USD; variance not calculable. |
| Cohort: 1 (1,606) | Insufficient | High study limitations, consistency unknown, indirect, precise | Calculated mean difference for MTM vs. same-country control, 80.40 USD; 95% CI, 10.43 to 150.37; p = 0.024. Calculated mean difference for MTM vs. different country control, 88.60 USD; 95% CI, 24.61 to 152.59; p = 0.007. | |
| Medication costs: health plan expenditures | RCT: 3 (965) | Low for benefit | Medium study limitations, consistent, indirect, imprecise | Mean difference varies from -34 CAD to -293 USD over 6 months. |
| NRCT and cohort: 5 (120 to 200,722) | Insufficient | High study limitations, inconsistent, indirect, imprecise | Mean difference varies from -800 USD over 1 year to 425 USD over 2 years. | |
| Medication costs: total outlays | RCT: 6 (2,636) | Insufficient | Medium study limitations, inconsistent, indirect, imprecise | Mean difference varies from -20.16 USD to +5.25 USD per month. |
| Cohort: 2 (177,565) | Insufficient | High study limitations, inconsistent, indirect, imprecise | Mean difference varies from -563 USD to +310 USD annually. | |
| Medication costs: medication costs plus other expenditures | RCT: 2 (996) | Insufficient | Medium study limitations, inconsistent, indirect, imprecise | Differences in mean costs range from -8.1 CAD to 1,947 USD. |
| NRCT and cohort: 3 (5,300) | Insufficient | High study limitations, inconsistent, indirect, imprecise | Differences in mean costs range from -1,039 to 1,100 USD. | |
| Number of outpatient visits | RCT: 3 (2,208) | Insufficient | Medium study limitations, inconsistent, indirect, precise | Standardized mean difference, 0.049; 95% CI, -0.034 to 0.133; p = 0.247; I2 = 0. |
| Cohort: 1 (4,500) | Insufficient | High study limitations, consistency unknown, indirect, imprecise | Calculated mean difference, 2.48; 95% CI, 1.674 to 3.286; p <0.001. | |
| Outpatient costs | RCT: 3 (2,050) | Insufficient | Medium study limitations, inconsistent, indirect, imprecise | Variable estimates. |
| Number of laboratory tests | RCT: 2 (1,842) | Insufficient | Medium study limitations, inconsistent, indirect, imprecise | Differences range from +0.15 to -1.6 tests. |
| Costs of laboratory tests | RCT: 3 (2,050) | Insufficient | Medium study limitations, inconsistent, indirect, imprecise | Differences range from +15 CAD to -140 USD. |
| Number of emergency department visits | RCT: 3 (1,552) | Insufficient | Medium study limitations, inconsistent, direct, imprecise | Mean difference ranges from -0.7 (p not significant) to -0.03 (95% CI, -0.113 to 0.053). |
| Observational: 3 (795 to 200,722) | Insufficient | High study limitations, inconsistent, direct, imprecise | Adjusted OR ranges from 0.89 (95% CI, 0.6 to 1.3) to 1.09; mean difference (1 study), 0.04; 95% CI, -0.043 to 0.123; p = 0.346. | |
| Costs of emergency department visits | RCT: 2 (996) | Insufficient | Medium study limitations, consistent, direct, imprecise | Mean difference ranges from -52 USD to -5.6 CAD. |
| Cohort: 1 (150,470 to 200,722) | Insufficient | High study limitations, consistency unknown, direct, imprecise | Difference ranges from -16 USD to +12.8 USD. | |
| Hospitalization: number | RCT: 3 (2,208) | Low for no benefit | Medium study limitations, consistent, direct, precise | Mean difference, 0.037; 95% CI, -0.004 to 0.080. |
| Cohort: 1 (4,500) | Low for benefit | High study limitations, consistency unknown, direct, precise | Mean difference, -0.21; 95% CI, -0.265 to -0.155; p <0.001. | |
| Hospitalization: risk | RCT: 1 (556) | Insufficient | Low study limitations, consistency unknown, direct, imprecise | OR for basic MTM vs. usual care, 2.069; 95% CI, 1.104 to 3.878; p = 0.02. OR for enhanced MTM vs. usual care, 1.345; 95% CI, -0. 693 to 2.609; p = 0.381. |
| Cohort—CHF, COPD, or unspecified: 3 (795 to 200,722) Diabetes: 1 (150,470) | CHF, COPD, or unspecified: insufficient Diabetes: low for benefit | High study limitations, inconsistent, direct, imprecise High study limitations, consistency unknown, direct, precise | Adjusted OR ranges from 0.90 to 1.4. OR ranges from 0.91 to 0.93. | |
| Hospitalization: rate (patients with heart failure and home medicine review) | Cohort: 1 (5,717) | Low for benefit | High study limitations, consistency unknown, direct, precise | Adjusted HR, 0.55; 95% CI, 0.39 to 0.77. |
| Costs of hospitalization | 3; 2,151 (2,050) | Insufficient | Medium study limitations, inconsistent, direct, imprecise | Inconsistent direction of effect but consistent in lack of significant effect. |
| CHF or COPD: 1 (169,099 to 200,722) Diabetes: 1 (150,470) | Insufficient for CHF or COPD Low for benefit for diabetes | High study limitations, consistency unknown, direct, imprecise High study limitations, consistency unknown, direct, precise | Differences range from -526 USD to 200 USD for CHF and COPD. Differences range from -363 USD to -399 USD for diabetes. | |
| Length of hospital stay | RCT: 1 (208) | Insufficient | Low study limitations, consistency unknown, direct, imprecise | MTM reduced length of stay 1.8 days. |
CAD = Canadian dollar; CHF = congestive heart failure; CI = confidence interval; COPD = chronic obstructive pulmonary disease; HR = hazard ratio; MTM = medication therapy management; NR = not reported; NRCT = nonrandomized controlled trial; OR = odds ratio; RCT = randomized controlled trial; USD = U.S. dollar.
From: Executive Summary
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