Cost analysis of potentially inappropriate medication in older hospitalized patients

ABSTRACT

Objectives: Pubmed literature search show that the prescription of potentially inappropriate medications is a major concern in older hospitalized patients, both from a clinical and financial perspective. This study aims to identify factors associated with exposure and potentially inappropriate medication costs in older hospitalized patients and to assess the financial impact of substituting these medications with safer alternatives.

Methods: We performed an observational cross-sectional study of all patients aged 75 years or older hospitalized in a university hospital (except geriatric wards) on a given day. Potentially inappropriate medications were identified using European and French guidelines.

Results: A total of 365 patients were included. At least one potentially inappropriate medication was prescribed in 50.4% of these patients. This contributed 19.7% [16.1; 23.6] to the average cost of medication per patient. Substitution of these medications with recommended alternatives was cost saving: average incremental cost per patient: −3.97 € [−7.21; −1.58]. Both polypharmacy and type of ward providing care were associated with increased costs of potentially inappropriate medications.

Conclusions: This study assessed the prevalence of potentially inappropriate medications in older hospitalized patients and established that their substitution by alternative medications provided a cost saving.

KEYWORDS:

• Inappropriate medication
• older patients
• hospital
• cost analysis
• alternative medication

Article highlights

• The prescription of potentially inappropriate medications is a major concern in older hospitalized patients, both from a clinical and financial perspective.

• We performed an observational cross-sectional study of 365 patients aged 75 years or older who were hospitalized in a university hospital on a given day (excluding geriatric wards).

• At least one potentially inappropriate medication was prescribed in 50.4% of these patients. This contributed 19.7% to the average cost of medication per patient.

• Substitution of these medications with recommended alternatives provided a statistically significant saving (average incremental cost per patient of: −3.97 €, 95% confidence interval = [−7.21 €; −1.58 €]).

• Both polypharmacy and the type of ward providing care were associated with the increased costs of potentially inappropriate medications.

Declaration of interest

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

All authors were involved in the conception and design of the study and data interpretation. AP, MM, and CC were involved in collecting the data. AP, MM, LR, and BJC were involved in the statistic and economic analyses, and in preparing and revising the manuscript. CM, PC, and BJC provided essential advice on the focus of the analysis, methodology, and economic impact. All authors jointly made the decision to submit the manuscript for publication.

Geolocation information

France

Additional information

Funding

This paper was not funded.