Deprescribing Interventions in Older Adults with Polypharmacy: A Systematic Review of Economic Evaluations.

backgroundDeprescribing is increasingly promoted to address polypharmacy and medication-related harm in older adults. However, its economic value as a distinct intervention remains unclear, as prior reviews have often conflated deprescribing with broader medication optimisation strategies. This systematic review synthesises the economic evidence on deprescribing using a strict conceptual definition.

methodsA systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted from January 2000 to June 2025. Studies were included if they reported full economic evaluations (cost-effectiveness, cost-utility, cost-benefit, or cost-consequence analyses) of interventions explicitly involving medication discontinuation in adults aged ≥ 65 years. The methodological quality of included studies was assessed using the Consensus on Health Economic Criteria (CHEC) checklist, and reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 statement. Cost data were standardised to 2024 US dollars using purchasing power parity where feasible.

resultsEight studies were included (two trial-based, six model-based). Deprescribing interventions targeting medications with well-established harm profiles, such as sedatives, non-steroidal anti-inflammatory drugs, and proton pump inhibitors (prolonged use), were most consistently cost-saving or dominant, primarily through reductions in adverse drug events. In contrast, evidence for antihypertensive deprescribing was limited and context dependent, with one model-based study suggesting potential long-term harms under specific assumptions. Across studies, economic outcomes were strongly influenced by intervention design and implementation, with structured, multi-component approaches demonstrating greater effectiveness. Quality assessment indicated generally robust methodological foundations but identified gaps in the handling of uncertainty, transparency in reporting, and the inclusion of broader cost components.

conclusionDeprescribing can represent good value for money when targeted to high-risk medications and supported by structured implementation strategies. Its economic value is not universal but depends on patient context, medication class, and intervention design. Future research should prioritise methodologically rigorous, transparent, and context-sensitive economic evaluations to inform policy and practice.