Analysis of Adverse Reactions Caused by Potentially Inappropriate Prescriptions and Related Medical Costs That Are Avoidable Using the Beers Criteria: The Japanese Version and Guidelines for Medical Treatment and Its Safety in the Elderly 2015

Abstract

We conducted a retrospective study to investigate adverse drug reactions and associated medical costs among elderly individuals that could be avoided if pharmacotherapy was performed in accordance with the Beers Criteria: the Japanese Version (BCJV) and Guidelines for Medical Treatment and Its Safety in the Elderly 2015 (GL2015). Patients aged at least 65 years who were either hospitalized at Gifu Municipal Hospital between October 1 and November 30, 2014 (n 1236) or had outpatient examinations at Gifu Municipal Hospital on October 1-2, 2014 (n 980) were included in the study. The outcomes measured were usage rates of drugs listed in the BCJV and GL2015, incidence rates of adverse drug reactions, and additional costs incurred per patient due to adverse reactions. Among the inpatients, usage rates of drugs listed in the BCJV and GL2015 were 24.0 and 72.4%, respectively, and adverse reactions to these drugs occurred at rates of 3.0 and 8.2%, respectively. Among the outpatients, while the usage rates were 26.2% (BCJV) and 59.9% (GL2015), the incidence rates of adverse reactions were 4.7% (BCJV) and 3.9% (GL2015). The additional costs incurred due to adverse drug reactions ranged from 12713-163925 yen per patient. Our results demonstrate that appropriate use of drugs based on the BCJV and GL2015 can help prevent adverse reactions; this would reduce the overall medical costs.

Potentially inappropriate prescribing and its associations with health‐related and system‐related outcomes in hospitalised older adults: A systematic review and meta‐analysis

“…Of these, 103 articles were excluded, mainly because studies reported a different outcome of interest ( n = 58). The final screening identified 63 studies 33–95 suitable for inclusion in this review (Figure 1).…”

“…evaluated the mean cost of PIMs using STOPP v2 and determined that the cost associated with PIM use was €18.75 ± 4.24 per patient per month (€225.14 ± 50.91 per patient per year), with opioids accounting for the highest percentage of the expenditure. Similarly, Tachi et al 88 . calculated the extra cost for treatment of adverse reactions per inpatient who was prescribed drugs listed in the Beers Criteria–Japanese Version and Guidelines for Medical Treatment and its Safety in the Elderly 2015 and was estimated to range from 497 to 13 371 yen per patient (≈7–180 AUD), which corresponds to a national cost of 2.18–381.42 (≈0.03–5 AUD) billion yen per year.…”

“…Three studies reported the economic costs of PIMs. 58,80,88 No studies reported cost implications of PPOs. Hagstrom et al 58…”

“…Twenty-three studies assessed the impact of PIPs on the occurrence of ADRs/ADEs, either through analysing the association between PIMs and ADRs/ADEs 47,59,67,[76][77][78][79][81][82][83]86,89,91,94 or simply reporting only the share of PIMs in the occurrence of ADRs/ ADEs. 40,53,63,67,70,71,87,88,95 Links between PPOs and ADRs/ADEs…”

“…Three studies reported the economic costs of PIMs. 58,80,88 No studies reported cost implications of PPOs. Hagstrom et al 58 Overall, whether the estimation was on total hospital costs, or the extra costs due to PIMs and treatment of PIM-related ADRs, the use of PIM was associated with higher economic cost.…”