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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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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.

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Acknowledgements

We thank Florian Bleibler (Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf) for suggesting the application of the entropy balancing procedure.

Author Contributions

All authors made substantial contributions to the conception and design of the work, and the acquisition and interpretation of data for the work. DH and J-BA prepared the data. DH and HM conducted the data analysis. DH and H-HK drafted the work and all authors revised it critically for important intellectual content and approved the final version for submission. All authors agreed to be accountable for all aspects of the work and ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. DH and HM had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. DH is the study guarantor.

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Authors and Affiliations

  1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany

    Dirk Heider, Herbert Matschinger & Hans-Helmut König

  2. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany

    Andreas D. Meid, Renate Quinzler & Walter E. Haefeli

  3. Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, Berlin, 10178, Germany

    Jürgen-Bernhard Adler & Christian Günster

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  1. Dirk Heider
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  2. Herbert Matschinger
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  3. Andreas D. Meid
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  7. Walter E. Haefeli
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  8. Hans-Helmut König
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Correspondence to Dirk Heider.

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Funding

The HEPIME study was funded by the Federal Ministry of Education and Research (BMBF) under Project No. 01GY1329A.

Conflict of interest

Walter E. Haefeli is a member of the scientific advisory board and a shareholder of Dosing GmbH, the company distributing the clinical decision support software used in this study. His wife is an employee of Dosing GmbH. Dirk Heider, Herbert Matschinger, Andreas Meid, Renate Quinzler, Jürgen-Bernhard Adler, Christian Günster, and Hans-Helmut König declare that they have no conflicts of interest relevant to this study.

Transparency

The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been disclosed.

Ethics approval

For this type of study, formal consent is not required.

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Heider, D., Matschinger, H., Meid, A.D. et al. Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study. Drugs Aging 34, 289–301 (2017). https://doi.org/10.1007/s40266-017-0441-2

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