Prevalence and direct costs of potentially inappropriate prescriptions in France: a population-based study

ABSTRACT

Background

Potentially inappropriate prescriptions (PIPs) in the older population remain a growing public health concern due to the many associated adverse events increasing healthcare service use and health costs. This study aimed to assess the prevalence and direct costs of PIPs in older adults aged ≥65 years in France.

Methods

A population-based cross-sectional study was conducted in 2017 using a representative sample of the French national healthcare reimbursement system database. PIPs were defined using the French REMEDI[e]S tool. Overall reimbursed direct costs and by PIP category were extrapolated to the French older population.

Results

The overall PIP prevalence was estimated at 56.7% (95% CI: 56.4–57.0). Medications with an unfavorable benefit/risk ratio had the highest prevalence (34.0%, 95% CI: 33.7–34.3). Direct costs associated with PIPs represented 6.3% of the total reimbursed medication costs in 2017 (€507 million). Drug duplications were the main contributors to these costs (39.2% of the total reimbursed PIP costs, €199 million) and among all PIPs, proton pump inhibitors (>8 weeks) were the most expensive PIPs (€152 million).

Conclusions

PIP prevalence is still high among French older adults, with substantial direct costs. Large-scale interventions targeting the most prevalent and/or costly PIPs are needed to reduce their clinical and economic impacts.

KEYWORDS:

• Older adults
• potentially inappropriate prescriptions
• drug utilization
• medication cost
• insurance health reimbursement
• pharmacoepidemiology

Acknowledgments

The authors thank Michaël Genin, PhD (Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France) for providing statistical support in this article for the realization of geographical maps.

Author Contributions

All authors (BR, JB, CM, PN, and MLL) were involved in the conception and design of the study, the analysis and interpretation of the data. BR was involved in the drafting of the paper, and all authors were involved in revising it critically for intellectual content. All authors have approved the final approval of the version to be published, and they agreed to be accountable for all aspects of the work.

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.

Ethical approval

In accordance with French regulations, ethics committee approval was not required for this observational study conducted on anonymized medico-administrative data.

Reviewer Disclosures

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

Supplementary Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This manuscript was not funded.