Summary: In a cost analysis of a trial in psychiatric outpatients with diabetes, physician-led medication reviews reduced the number of drugs and potentially inappropriate prescriptions and cut phone contacts, while being cost-neutral overall.
PICO Summary
| Element | Detail |
|---|---|
| Population | 48 outpatients with severe mental disorders and comorbid diabetes; cost-minimization analysis of a randomised trial, Denmark. |
| Intervention | Physician-led medication reviews via interdisciplinary dialogue between psychiatrists and clinical pharmacologists. |
| Comparison | Standard care without structured medication review. |
| Outcome | The intervention group reduced the median number of drugs and potentially inappropriate prescriptions by 1, versus a median increase of 2 in controls. There was no significant difference in overall healthcare costs (cost-neutral), though the intervention group had fewer telephone contacts with the healthcare system (median 6.5 vs 14). |
Expert Commentary
This is a pragmatic health-economics companion to a clinical trial, and its framing as cost-minimization is exactly right, since the question is not whether the intervention saves money but whether a worthwhile prescribing improvement can be delivered without adding cost. On that question the answer is encouraging: structured interdisciplinary review reduced both medication count and potentially inappropriate prescriptions in a population especially prone to polypharmacy, while the control group’s regimens drifted upward, and it did so cost-neutrally with fewer patient-initiated phone contacts. The honest caveats, which the post states, are important. With only 48 patients the study is underpowered for cost outcomes, which are notoriously high-variance, so cost-neutrality should be read as no detectable difference rather than proven equivalence. It sits within the Danish system and may not transfer to other financing structures, the clinical outcomes that ultimately matter, psychiatric stability, glycaemic control, and adverse events, were not primary endpoints, and the model depends on psychiatrist-pharmacologist collaboration not available everywhere. Can I use this with my patients? Yes, as support for a practice I already value. It reinforces periodic comprehensive medication review for people with serious mental illness and diabetes, where deprescribing is both safe and beneficial, while I would confirm the health impact through the clinical rather than the cost data.
References
Christensen JFMM, Kolbye A, Jürgens G. Facilitating the implementation of physician-led medication reviews for patients with severe mental disorder and diabetes: a cost-minimization analysis. Basic Clin Pharmacol Toxicol. 2026;138(1):e70175. doi:10.1111/bcpt.70175