Abstract
BackgroundIn the growing population of the elderly, drug-related problems are considered an important health care safety issue. One aspect of this is the prescription of potentially inappropriate medication (PIM) which is considered to increase health care costs.ObjectiveUsing data from the Health Economics of Potentially Inappropriate Medication (HEPIME) study, we aimed to analyze how the number of prescribed substances moderates the association of PIM use as defined by the German PRISCUS list and health care costs applying a longitudinal perspective.MethodsAn initial number of 6,849,622 insurants aged 65+ of a large German health insurance company were included in a retrospective matched cohort study. Based on longitudinal claims data from the four separate quarters of a 12-month pre-period, 3,860,842 individuals with no exposure to PIM in 2011 were matched to 508,212 exposed individuals. Exposure effects of PIM use on health care costs and the number of prescribed substances were measured based on longitudinal claims data from the four separate quarters of the 12-month post-period.ResultsAfter successful balancing for the development of numerous matching variables during the four quarters of the pre-period, exposed individuals consumed 2.1 additional prescribed substances and had higher total health care costs of 1,237 € when compared to non-exposed individuals in the 1st quarter of the post-period. Controlling for the number of prescribed substances, the difference in total health care costs between both study groups was 401 €. The average effect of one additionally prescribed substance (other than PIM) on total health care costs was increased by an amount of 137 € for those being exposed to a PIM. In quarters 2–4 of the post-period, the differences between both study groups tended to decrease sequentially.ConclusionsPIM use has an increasing effect on the development of health care costs. This cost-increasing effect of PIM use is moderated by the number of prescribed substances.
Highlights
For older individuals, pharmacotherapy is a fundamental component of health care [1]
Impact of potentially inappropriate medication on the development of health care costs moderated by medication
potentially inappropriate medication (PIM) use has an increasing effect on the development of health care costs. This costincreasing effect of PIM use is moderated by the number of prescribed substances
Summary
For older individuals, pharmacotherapy is a fundamental component of health care [1]. The occurrence of age-related changes in pharmacokinetics and pharmacodynamics entails an increased risk of adverse drug reactions in the elderly [3]. This is even more important when older individuals are exposed to polypharmacy which, according to common definitions, is the use of five or more medications. In the growing population of the elderly, drug-related problems are considered an important health care safety issue. One aspect of this is the prescription of potentially inappropriate medication (PIM) which is considered to increase health care costs
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