Effective deprescribing strategies for reducing potentially inappropriate medications and improving economic outcomes in community-based settings: a systematic review and meta-analysis

Deprescribing is a valuable approach to reducing inappropriate medication use, particularly in older adults and patients concurrently using high numbers of medications (polypharmacy). While previous research has focused on specific drug classes or patient populations, the overall effects of deprescribing in a community-based setting remain unclear. This systematic review and meta-analysis aims to assess the effectiveness of deprescribing interventions in community-based settings regarding economic outcomes and patient safety, measured as the reduction of potentially inappropriate medication. We conducted a comprehensive search across Embase, Central, and Medline with studies published prior to 20th April 2025. Data was extracted and narratively summarized according to a standardized protocol, and a meta-analysis was performed with a selection of the included studies. Risk of bias was assessed with the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized controlled trials (NRCTs). The systematic review included 27 studies, of which nine were included in the meta-analysis. The meta-analysis showed significant results, indicating that deprescribing interventions reduced prescribing-related medication use, including potentially inappropriate medications (PIMs) and specific medication types, in community-based settings, with an effect size of -0.3234 (SE = 0.1378). The descriptive outcomes further support the result that deprescribing interventions may lead to a reduction in PIMs. Additionally, eight studies assessing economic outcomes, like cost-effectiveness and cost-utility, consistently found that deprescribing interventions led to healthcare cost savings. This is the first meta-analysis to examine deprescribing in a broad, community-based setting without focusing on a specific patient group or medication type. The meta-analysis confirmed significant effects, and the descriptive findings, along with economic assessments, further support the benefits of deprescribing. However, further studies are needed to address remaining uncertainties regarding long-term outcomes and the scalability of deprescribing strategies across diverse healthcare systems. Not applicable.