Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study
Background Drug-related problems are an important healthcare safety concern in the growing population of older people. Prescription of potentially inappropriate medication (PIM) is one aspect of this concern that is considered to increase the risk of adverse health outcomes. Objective The aim of the...
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| Veröffentlicht in: | Drugs & aging 2017-04, Vol.34 (4), p.289-301 |
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| creator | Heider, Dirk Matschinger, Herbert Meid, Andreas D. Quinzler, Renate Adler, Jürgen-Bernhard Günster, Christian Haefeli, Walter E. König, Hans-Helmut |
| description | Background
Drug-related problems are an important healthcare safety concern in the growing population of older people. Prescription of potentially inappropriate medication (PIM) is one aspect of this concern that is considered to increase the risk of adverse health outcomes.
Objective
The aim of the Health Economics of Potentially Inappropriate Medication (HEPIME) study was to analyze the association between the prescription of PIMs according to the German PRISCUS list and healthcare utilization, healthcare costs, and the occurrence of adverse events in old age.
Methods
Insurants of a large German health insurance company aged 65+ years were included in a retrospective matched cohort study. A total of 3,953,423 individuals with no exposure to PIM in 2011 were matched to 521,644 exposed individuals and compared in terms of outpatient healthcare utilization, healthcare costs, and the occurrence of adverse events in outpatient, hospital, and rehabilitation sectors during a 12-month follow-up.
Results
On average, individuals in the exposed group had additional 143 [95% confidence interval (CI) 140–146] daily defined doses of pharmaceuticals and 4.5 (95% CI 4.4–4.6) days in hospital. Mean annual total healthcare costs per individual in the exposed group exceeded those in the non-exposed group by €2321 (95% CI 2269–2372), resulting mainly from differences in hospitalization costs of €1718 (95% CI 1678–1759). Odds ratios for the occurrence of adverse events in the exposed group were 1.32 (95% CI 1.32–1.34) in the outpatient sector, 1.76 (95% CI 1.73–1.79) in the hospital sector, and 1.82 (95% CI 1.76–1.89) in the rehabilitation sector.
Conclusions
Increased healthcare utilization and costs as well as an increased probability for adverse events in individuals exposed to PIM demonstrate the health economic relevance of PIM prescriptions. Whether avoiding PIM listed on the PRISCUS list may potentially improve the quality and efficiency of healthcare is currently unknown. |
| doi_str_mv | 10.1007/s40266-017-0441-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1870987613</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1973307810</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-657fe545ddd42553f0957bbb8d8f295c7de8ae88a0d6d2e20a4b47aa17763763</originalsourceid><addsrcrecordid>eNp1kd9qFDEUxoMotlYfwBsJeONFR08yf5LxbllqW6hUbAXvQiY5002ZTdYks7Lv4sOadauIIARyyPl9X07yEfKSwVsGIN6lBnjXVcBEBU3DKv6IHDMm-or1Xf_4Vw0V5_3XI_IspXsA6DhnT8kRl5w3XNbH5McF6imv6A3GrTNIvyQ8pcuQcjql2lu6sFuMCenZFn1OdJFSME5ntPS7K7JPIZdzp6dpRy-93mxi2MR9n35E64zOLnjqPL2eitUd7stzjGvtd-_pZ8wxpA2a7LaF19msiu0yrELM9CbPdvecPBn1lPDFw35Cbj-c3S4vqqvr88vl4qoyteC56loxYtu01tqGt209Qt-KYRiklSPvWyMsSo1SarCd5chBN0MjtGZCdHVZJ-TNwbZM_23GlNXaJYPTpD2GOSkmBfRSdKwu6Ot_0PswR1-GU6wXdQ1CMigUO1CmPDBFHFX5lLWOO8VA7ZNTh-RUSU7tk1O8aF49OM_DGu0fxe-oCsAPQCotf4fxr6v_6_oTg8ykvA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1973307810</pqid></control><display><type>article</type><title>Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Heider, Dirk ; Matschinger, Herbert ; Meid, Andreas D. ; Quinzler, Renate ; Adler, Jürgen-Bernhard ; Günster, Christian ; Haefeli, Walter E. ; König, Hans-Helmut</creator><creatorcontrib>Heider, Dirk ; Matschinger, Herbert ; Meid, Andreas D. ; Quinzler, Renate ; Adler, Jürgen-Bernhard ; Günster, Christian ; Haefeli, Walter E. ; König, Hans-Helmut</creatorcontrib><description>Background
Drug-related problems are an important healthcare safety concern in the growing population of older people. Prescription of potentially inappropriate medication (PIM) is one aspect of this concern that is considered to increase the risk of adverse health outcomes.
Objective
The aim of the Health Economics of Potentially Inappropriate Medication (HEPIME) study was to analyze the association between the prescription of PIMs according to the German PRISCUS list and healthcare utilization, healthcare costs, and the occurrence of adverse events in old age.
Methods
Insurants of a large German health insurance company aged 65+ years were included in a retrospective matched cohort study. A total of 3,953,423 individuals with no exposure to PIM in 2011 were matched to 521,644 exposed individuals and compared in terms of outpatient healthcare utilization, healthcare costs, and the occurrence of adverse events in outpatient, hospital, and rehabilitation sectors during a 12-month follow-up.
Results
On average, individuals in the exposed group had additional 143 [95% confidence interval (CI) 140–146] daily defined doses of pharmaceuticals and 4.5 (95% CI 4.4–4.6) days in hospital. Mean annual total healthcare costs per individual in the exposed group exceeded those in the non-exposed group by €2321 (95% CI 2269–2372), resulting mainly from differences in hospitalization costs of €1718 (95% CI 1678–1759). Odds ratios for the occurrence of adverse events in the exposed group were 1.32 (95% CI 1.32–1.34) in the outpatient sector, 1.76 (95% CI 1.73–1.79) in the hospital sector, and 1.82 (95% CI 1.76–1.89) in the rehabilitation sector.
Conclusions
Increased healthcare utilization and costs as well as an increased probability for adverse events in individuals exposed to PIM demonstrate the health economic relevance of PIM prescriptions. Whether avoiding PIM listed on the PRISCUS list may potentially improve the quality and efficiency of healthcare is currently unknown.</description><identifier>ISSN: 1170-229X</identifier><identifier>EISSN: 1179-1969</identifier><identifier>DOI: 10.1007/s40266-017-0441-2</identifier><identifier>PMID: 28224283</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Cohort analysis ; Cohort Studies ; Comorbidity ; Female ; Geriatrics/Gerontology ; Germany ; Health Care Costs ; Health insurance ; Health Services for the Aged - utilization ; Humans ; Inappropriate Prescribing - adverse effects ; Inappropriate Prescribing - economics ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Older people ; Original Research Article ; Patient safety ; Pharmacology/Toxicology ; Pharmacotherapy ; Retrospective Studies</subject><ispartof>Drugs & aging, 2017-04, Vol.34 (4), p.289-301</ispartof><rights>Springer International Publishing Switzerland 2017</rights><rights>Copyright Springer Science & Business Media Apr 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-657fe545ddd42553f0957bbb8d8f295c7de8ae88a0d6d2e20a4b47aa17763763</citedby><cites>FETCH-LOGICAL-c372t-657fe545ddd42553f0957bbb8d8f295c7de8ae88a0d6d2e20a4b47aa17763763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40266-017-0441-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40266-017-0441-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28224283$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heider, Dirk</creatorcontrib><creatorcontrib>Matschinger, Herbert</creatorcontrib><creatorcontrib>Meid, Andreas D.</creatorcontrib><creatorcontrib>Quinzler, Renate</creatorcontrib><creatorcontrib>Adler, Jürgen-Bernhard</creatorcontrib><creatorcontrib>Günster, Christian</creatorcontrib><creatorcontrib>Haefeli, Walter E.</creatorcontrib><creatorcontrib>König, Hans-Helmut</creatorcontrib><title>Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study</title><title>Drugs & aging</title><addtitle>Drugs Aging</addtitle><addtitle>Drugs Aging</addtitle><description>Background
Drug-related problems are an important healthcare safety concern in the growing population of older people. Prescription of potentially inappropriate medication (PIM) is one aspect of this concern that is considered to increase the risk of adverse health outcomes.
Objective
The aim of the Health Economics of Potentially Inappropriate Medication (HEPIME) study was to analyze the association between the prescription of PIMs according to the German PRISCUS list and healthcare utilization, healthcare costs, and the occurrence of adverse events in old age.
Methods
Insurants of a large German health insurance company aged 65+ years were included in a retrospective matched cohort study. A total of 3,953,423 individuals with no exposure to PIM in 2011 were matched to 521,644 exposed individuals and compared in terms of outpatient healthcare utilization, healthcare costs, and the occurrence of adverse events in outpatient, hospital, and rehabilitation sectors during a 12-month follow-up.
Results
On average, individuals in the exposed group had additional 143 [95% confidence interval (CI) 140–146] daily defined doses of pharmaceuticals and 4.5 (95% CI 4.4–4.6) days in hospital. Mean annual total healthcare costs per individual in the exposed group exceeded those in the non-exposed group by €2321 (95% CI 2269–2372), resulting mainly from differences in hospitalization costs of €1718 (95% CI 1678–1759). Odds ratios for the occurrence of adverse events in the exposed group were 1.32 (95% CI 1.32–1.34) in the outpatient sector, 1.76 (95% CI 1.73–1.79) in the hospital sector, and 1.82 (95% CI 1.76–1.89) in the rehabilitation sector.
Conclusions
Increased healthcare utilization and costs as well as an increased probability for adverse events in individuals exposed to PIM demonstrate the health economic relevance of PIM prescriptions. Whether avoiding PIM listed on the PRISCUS list may potentially improve the quality and efficiency of healthcare is currently unknown.</description><subject>Aged</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Geriatrics/Gerontology</subject><subject>Germany</subject><subject>Health Care Costs</subject><subject>Health insurance</subject><subject>Health Services for the Aged - utilization</subject><subject>Humans</subject><subject>Inappropriate Prescribing - adverse effects</subject><subject>Inappropriate Prescribing - economics</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Older people</subject><subject>Original Research Article</subject><subject>Patient safety</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Retrospective Studies</subject><issn>1170-229X</issn><issn>1179-1969</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kd9qFDEUxoMotlYfwBsJeONFR08yf5LxbllqW6hUbAXvQiY5002ZTdYks7Lv4sOadauIIARyyPl9X07yEfKSwVsGIN6lBnjXVcBEBU3DKv6IHDMm-or1Xf_4Vw0V5_3XI_IspXsA6DhnT8kRl5w3XNbH5McF6imv6A3GrTNIvyQ8pcuQcjql2lu6sFuMCenZFn1OdJFSME5ntPS7K7JPIZdzp6dpRy-93mxi2MR9n35E64zOLnjqPL2eitUd7stzjGvtd-_pZ8wxpA2a7LaF19msiu0yrELM9CbPdvecPBn1lPDFw35Cbj-c3S4vqqvr88vl4qoyteC56loxYtu01tqGt209Qt-KYRiklSPvWyMsSo1SarCd5chBN0MjtGZCdHVZJ-TNwbZM_23GlNXaJYPTpD2GOSkmBfRSdKwu6Ot_0PswR1-GU6wXdQ1CMigUO1CmPDBFHFX5lLWOO8VA7ZNTh-RUSU7tk1O8aF49OM_DGu0fxe-oCsAPQCotf4fxr6v_6_oTg8ykvA</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Heider, Dirk</creator><creator>Matschinger, Herbert</creator><creator>Meid, Andreas D.</creator><creator>Quinzler, Renate</creator><creator>Adler, Jürgen-Bernhard</creator><creator>Günster, Christian</creator><creator>Haefeli, Walter E.</creator><creator>König, Hans-Helmut</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170401</creationdate><title>Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study</title><author>Heider, Dirk ; Matschinger, Herbert ; Meid, Andreas D. ; Quinzler, Renate ; Adler, Jürgen-Bernhard ; Günster, Christian ; Haefeli, Walter E. ; König, Hans-Helmut</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-657fe545ddd42553f0957bbb8d8f295c7de8ae88a0d6d2e20a4b47aa17763763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Geriatrics/Gerontology</topic><topic>Germany</topic><topic>Health Care Costs</topic><topic>Health insurance</topic><topic>Health Services for the Aged - utilization</topic><topic>Humans</topic><topic>Inappropriate Prescribing - adverse effects</topic><topic>Inappropriate Prescribing - economics</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Older people</topic><topic>Original Research Article</topic><topic>Patient safety</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heider, Dirk</creatorcontrib><creatorcontrib>Matschinger, Herbert</creatorcontrib><creatorcontrib>Meid, Andreas D.</creatorcontrib><creatorcontrib>Quinzler, Renate</creatorcontrib><creatorcontrib>Adler, Jürgen-Bernhard</creatorcontrib><creatorcontrib>Günster, Christian</creatorcontrib><creatorcontrib>Haefeli, Walter E.</creatorcontrib><creatorcontrib>König, Hans-Helmut</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Drugs & aging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heider, Dirk</au><au>Matschinger, Herbert</au><au>Meid, Andreas D.</au><au>Quinzler, Renate</au><au>Adler, Jürgen-Bernhard</au><au>Günster, Christian</au><au>Haefeli, Walter E.</au><au>König, Hans-Helmut</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study</atitle><jtitle>Drugs & aging</jtitle><stitle>Drugs Aging</stitle><addtitle>Drugs Aging</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>34</volume><issue>4</issue><spage>289</spage><epage>301</epage><pages>289-301</pages><issn>1170-229X</issn><eissn>1179-1969</eissn><abstract>Background
Drug-related problems are an important healthcare safety concern in the growing population of older people. Prescription of potentially inappropriate medication (PIM) is one aspect of this concern that is considered to increase the risk of adverse health outcomes.
Objective
The aim of the Health Economics of Potentially Inappropriate Medication (HEPIME) study was to analyze the association between the prescription of PIMs according to the German PRISCUS list and healthcare utilization, healthcare costs, and the occurrence of adverse events in old age.
Methods
Insurants of a large German health insurance company aged 65+ years were included in a retrospective matched cohort study. A total of 3,953,423 individuals with no exposure to PIM in 2011 were matched to 521,644 exposed individuals and compared in terms of outpatient healthcare utilization, healthcare costs, and the occurrence of adverse events in outpatient, hospital, and rehabilitation sectors during a 12-month follow-up.
Results
On average, individuals in the exposed group had additional 143 [95% confidence interval (CI) 140–146] daily defined doses of pharmaceuticals and 4.5 (95% CI 4.4–4.6) days in hospital. Mean annual total healthcare costs per individual in the exposed group exceeded those in the non-exposed group by €2321 (95% CI 2269–2372), resulting mainly from differences in hospitalization costs of €1718 (95% CI 1678–1759). Odds ratios for the occurrence of adverse events in the exposed group were 1.32 (95% CI 1.32–1.34) in the outpatient sector, 1.76 (95% CI 1.73–1.79) in the hospital sector, and 1.82 (95% CI 1.76–1.89) in the rehabilitation sector.
Conclusions
Increased healthcare utilization and costs as well as an increased probability for adverse events in individuals exposed to PIM demonstrate the health economic relevance of PIM prescriptions. Whether avoiding PIM listed on the PRISCUS list may potentially improve the quality and efficiency of healthcare is currently unknown.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>28224283</pmid><doi>10.1007/s40266-017-0441-2</doi><tpages>13</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Cohort analysis Cohort Studies Comorbidity Female Geriatrics/Gerontology Germany Health Care Costs Health insurance Health Services for the Aged - utilization Humans Inappropriate Prescribing - adverse effects Inappropriate Prescribing - economics Internal Medicine Male Medicine Medicine & Public Health Older people Original Research Article Patient safety Pharmacology/Toxicology Pharmacotherapy Retrospective Studies |
| title | Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study |
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