Methods to control the pharmaceutical cost impact of chronic conditions in the elderly

Abstract

Multimorbidity is the main cause of polypharmacy in elderly people, with the consequent increment in cost and use of inappropriate medication. To control cost, specific strategies have been implemented in healthcare services to reduce potentially inappropriate prescription. Many interventions are applied online during the prescription process using computerized decision support systems, for example, therapeutic algorithms and alerts. Other interventions can be categorized as offline due to their application before or after the prescription process, the main strategies being financial incentives, medication reviews and organizational change. All these strategies are complementary and multifaceted. There is evidence that some of these interventions are effective, but further research should be directed in this field, including investigation of patient cost and outcomes.

Keywords:

• computerized support systems
• cost control
• inappropriate prescribing
• medication-related problems
• multimorbidity
• older people
• polypharmacy
• risk adjustment

Acknowledgements

The authors would like to thank J Wright for English editing.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Multimorbidity and polypharmacy have been identified as the main causes of increasing cost and pharmaceutical use in elderly patients.

• Diagnosis-based risk adjustment systems are used as general methods of pharmaceutical cost control on the financial side.

• Appropriate prescribing in elderly people may be optimized by multifaceted interventions applying explicit criteria to identify potential inappropriate prescribing.

• Computerized decision support and information system are essential for appropriate, safe and effective monitoring of prescribing and reducing medication-related problems in the elderly.

• The impact on cost of interventions to optimize prescribing is controversial and more evidence-based studies are needed.