Cost-Utility of Blister Versus Bulk Packaging All Medications for Veterans with Post-Traumatic Stress Disorder, Bipolar Affective Disorder, Major Affective Disorder or Schizophrenia: Results of a Pragmatic Randomized Trial

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Conference Proceeding

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OBJECTIVES: To estimate the cost-utility of blister versus bulk packaging of all prescribed medications for 303 Veterans with post-traumatic stress disorder, major affective disorder, bipolar affective disorder, and/or schizophrenia during a 12-month pragmatic randomized trial in Denver, Colorado, 2012-2014 (NCT01118208). METHODS: The perspective is that of the US Department of Veterans Health Affairs. Quality adusted life years (QALYs) were calculated as the area under the SF-6D curve as derived from baseline and monthly SF-36 assessments for 243 subjects (80.2%) who completed at least 2 assessments. The intervention was expected to improve adherence to prescriptions for indications beyond the eligibility criteria. Therefore, all VA utilization and costs were extracted from the VA Corporate Data Warehouse for the intervention period and expressed in 2012 dollars. Costs were estimated at $0.46 - $0.52 per blister card per 30 – 90 day prescription and $0.02 per bottle per prescription. Labor to fill blister cards was estimated at 10 – 15% more. The incremental cost effectiveness ratio (ICER) was calculated. RESULTS: The ICER point estimate was negative and blister packaging dominant, with both lower mean total costs ($19,170 vs $21,113) and higher mean QALYs (0.59 versus 0.58). Next steps include bootstrap replications and net benefit calculations to ascertain confidence in this point estimate. CONCLUSIONS: In this group of 236 Veterans, the point estimate suggests that blister packaging all prescription medications is both less expensive and produces higher quality of life than dispensing in bottles. LIMITATIONS: Blister packaging costs are based on cold seal and small-scale production and are likely higher than would be expected with mass production technologies and economics of scale. Medications filled outside of the VA system were not observed.



Presented at the annual meeting of the International Society for Pharmacoeconomics and Outcomes Research in Boston, Massachusetts, May 2017.

Abstract published in Value in Health Volume 20, Issue 5, May 2017, Page A29:

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