Abstract
Introduction:
Polypharmacy contributes to frailty, financially strains healthcare resources and causes unplanned hospital admissions. We audited how our Frailty Same Day Emergency Care (SDEC) addressed polypharmacy and the yearly financial impact of deprescribing on the NHS.
Method:
We analysed two months of patients seen and recorded medication changes in Excel. The BNF was used to provide the minimum NHS indicative price for a medication. Cost was calculated based on a year of prescribing for medications started, stopped or altered. For PRN medications, single pack usage was assumed. The average monthly saving was then multiplied by 12 to estimate the yearly value.
Results:
226 patients were reviewed, with 181 having recorded medication changes. From this sample, the estimated yearly saving through deprescribing is around £31,780. Furosemide, amlodipine and atorvastatin were the most frequently stopped. Anticipatory medication and laxatives were most frequently started. Stopping ticagrelor resulted in the greatest savings (£711.44), whilst the most expensive medication started was mesalazine granules (£897.16).
Limitations:
The estimated yearly saving is based on assumption and so can be subjected to anomalous results/prescribing. Alterations are assumed to be permanent and continue throughout the year. PRN usage was generalised and not reflective of true usage over a year. The estimated saving does not account for negative financial complications because of deprescribing (e.g. stopping stomach protection and then representing with an Upper GI Bleed). Whilst deprescribing can result in direct financial benefit to the NHS, true benefit has not been measured (reducing future admissions due to polypharmacy).
Conclusion:
The NHS can incur significant financial savings from a frailty day unit. The direct cost reduction of deprescribing is only one of the benefits of addressing polypharmacy. The true value is in improving quality of life, reducing the impact of frailty syndromes and avoiding hospital admissions in older people.