Impact of Low‐value Medications in Dementia on Patient‐reported Health‐related Quality of Life, Hospitalizations, and Direct Health Care Costs

Abstract

AbstractBackgroundPersons living with dementia (PwD) are commonly affected by low‐value medications (Lvm), i.e., medications unlikely to benefit patients but to cause harm. Lvm in PwD have been associated with negative physical, psychological, and financial outcomes. However, longitudinal effects have not yet been evaluated. Therefore, we aimed to analyze the impact of Lvm on patient‐centered outcomes among PwD over 24 months.MethodThis longitudinal analysis was based on 352 community‐dwelling PwD. Data were assessed at baseline and after 12 and 24 months. Medications that were explicitly not recommended were used to identify Lvm dichotomously (yes/no) and cumulatively (once, over one or two years). The 12‐Item Short‐Form Health Survey assessed patients' health‐related quality of life (HRQoL). Hospitalizations were assessed retrospectively for 12 months. Health care costs were monetarized by standardized unit costs. Multiple panel‐specific regression models were applied to analyze the impact of Lvm on HRQoL, hospitalizations and costs.ResultOver 24 months, 182 PwD (52%) received Lvm at least once and 56 (16%) continuously. The Lvm prevalence decreased from 36% (CI95% 30.8% – 40.8%) at baseline to 29% (CI95% 24.2% – 33.7%) two years later. Treating PwD with Lvm significantly increased the risk of hospitalization by 58% (CI95% 1.14 OR – 2.19 OR; p = 0.006), increased health care costs by €5,359 (CI95% ‐790€ – 11,508€; p = 0.088), and reduced patients' HRQoL (b = ‐1.81; CI95% ‐3.00 – ‐0.63; p = 0.003). HRQoL declined more strongly the longer that Lvm was received, whereas hospitalizations and health care costs were substantially affected by short‐term Lvm use, indicated by an increased hospitalization risk due to receiving Lvm over one year of 178% (CI95% 1.32 OR – 5.86 OR; p = 0.007) and costs for receiving Lvm once of €8,939 (CI95% €‐590€ – €18,469; p = 0.066).ConclusionMore than every second PwD received Lvm once, up to 12 months or continuously over 24 months, negatively impacting patient‐reported HRQoL, hospitalizations, and costs. While continuous Lvm intake decreased patients' HRQoL, receiving Lvm in the short term was relevant regarding further increases in hospitalizations and costs. Innovative approaches are needed to encourage prescribers to avoid and replace Lvm in dementia care.