More data needed for blister packages in nursing homes

The research, conducted by Institute for Quality and Efficiency in Health Care (IQWiG), was commissioned by the German Federal Ministry of Health due to controversial debate in Germany as to whether increased blister packaging for nursing home residents is suitable for relieving the burden on the long-term care system and sustainably improving the care of nursing home residents.

The results of the research showed that studies on patient-specific blister packaging have so far been predominantly conducted for the outpatient sector and no robust data is available for the nursing home sector. Even the common arguments put forward by various stakeholders and interest groups for or against more blister packaging in nursing homes are not scientifically proven. This also applies to the aspect of cost-effectiveness. 

The IQWiG researchers found a number of studies that investigated aspects of the benefit of blister packaging, but they all referred to an outpatient setting. No study investigated residential geriatric long-term care.

The studies originating from Germany are mainly before-and-after comparisons without a control group, which were evaluated in model projects by health insurance funds. However, the results of such studies are not very meaningful – both with regard to the benefit for nursing home residents and for the nursing staff. IQWiG therefore concludes that the benefit and harm of blister packaging in nursing homes remain unclear.

The evidence on the cost-effectiveness of blister packaging for nursing homes is also insufficient. IQWiG assumed that a weekly blister costs about €3 and that drug expenditure will decrease by 4.1 percent due to less waste. If at least €73.17 of costs for blistered drugs are incurred per week and resident, blister packaging would be cost-neutral. This, however, refers only to drug costs. Due to a lack of data, it is not possible to consider other monetary effects (due to fewer hospital referrals for example).

"The discrepancy between the broad and sometimes vehement debate about blister packaging on the one hand and the lack of evidence on the other surprised us," said Thomas Kaiser, Head of the IQWiG’s Drug Assessment Department. "Individual stakeholders and interest groups passionately argue for or against blister packaging, without being able to scientifically support their pros or cons. It is good that the commission from the Ministry of Health has now disclosed this.

"Our research has shown that high-quality studies are indeed available on other research questions in residential long-term care and that such studies are evidently feasible."

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