Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly

Abstract

Preventable adverse drug events (ADEs) represent a significant public health challenge for the older adult population, since they are associated with higher medical expenditures and more hospitalizations and emergency department (ED) visits. This study examines whether a novel medication risk prediction tool, the MedWise Risk Score™ (MRS), is associated with ADEs and other pertinent outcomes in participants of the Programs of All-Inclusive Care for the Elderly (PACE). Unlike other risk predictors, this tool produces actionable information that pharmacists can easily use to reduce ADE risk. This was a retrospective cross-sectional study that analyzed administrative medical claims data of 1965 PACE participants in 2018. To detect ADEs, we identified all claims that had ADE-related International Classification of Diseases and Health Related Problems, 10th revision (ICD-10) codes. Using logistic and linear regression models, we examined the association between the MRS and a variety of outcomes, including the number of PACE participants with an ADE, total medical expenditures, ED visits, hospitalizations, and hospital length of stay. We found significant associations for every outcome. Specifically, every point increase in the MRS corresponded to an 8.6% increase in the odds of having one or more ADEs per year (OR = 1.086, 95% CI: 1.060, 1.113), $1037 USD in additional annual medical spending (adjusted R2 of 0.739; p < 0.001), 3.2 additional ED visits per 100 participants per year (adjusted R2 of 0.568; p < 0.001), and 2.1 additional hospitalizations per 100 participants per year (adjusted R2 of 0.804; p < 0.001). Therefore, the MRS can risk stratify PACE participants and predict a host of important and relevant outcomes pertaining to medication-related morbidity.

Risk of Adverse Drug Events Following the Virtual Addition of COVID-19 Repurposed Drugs to Drug Regimens of Frail Older Adults with Polypharmacy

“…In older adults with polypharmacy, this hypothetical increase in MRS TM was primarily associated with an increase in CYP450 drug interaction burden and drug-induced LQTS scores. The MRS TM has been previously evaluated and validated in a sub-cohort of PACE participants as a medication risk prediction tool for ADE and medical outcomes including hospitalization, emergency department visits, and medical expenditure [21]. Bankes et al reported that each point increase in the MRS TM was significantly associated with an increase of ADE (OR = 1.09), additional emergency visits (+3 visits/ 100 patients/year), and an extra yearly medical expenditure of $1037.…”

“…A medication risk stratification was used to simulate the impact of different COVID-19 repurposed drugs on the MRS™ (see the Patent section of the manuscript for more details) [21][22][23]30]. The total MRS TM and the individual aggregated risk factors (FDA Adverse Event Reporting System (FAERS), anticholinergic cognitive burden (ACB), sedative burden (SB), drug-induced LQTS, and CYP450 drug interaction burden scores) were divided into sub-categories of Low risk, Moderate risk, and High risk.…”

“…For statistical significance, we considered p-values below 0.05 to be significant. A population's mean score change of at least 1 point was considered significant, as reported by Bankes et al [21]. To adjust for multiple comparisons, the Benjamini/Hochberg adjustment was applied.…”

“…Tabula Rasa HealthCare (TRHC) has developed a proprietary medication risk score, the MedWise Risk Score (MRS TM ), that uses algorithms to compute risk of adverse drug events (ADE) while considering five medication characteristics [ 21 , 22 , 23 ]: (1) computation of a drug regimen relative odds ratio for ADE using the FDA pharmacovigilance database (FDA Adverse Event Reporting System (FAERS)) [ 24 ], (2) anticholinergic cognitive burden (ACB) [ 25 ], (3) sedative burden (SB) [ 26 , 27 , 28 ], (4) drug-induced Long QT Syndrome (LQTS) burden [ 29 , 30 ], and (5) CYP450 drug interaction burden risk scores [ 31 ]. MRS TM is a predictive tool used by healthcare providers to assess patients’ likelihood of an ADE occurring; over 30 million individuals have been risk-stratified using this tool recently to direct pharmacists and health professional interventions for high-risk patients.…”

Mechanisms of CYP450 Inhibition: Understanding Drug-Drug Interactions Due to Mechanism-Based Inhibition in Clinical Practice

“…Although this may represent a preferred clinical strategy, the administration of two or more drugs at overlapping times increases the likelihood of drug-drug interactions [1,2]. As the risk of drug-drug interactions increases, the risk of debilitating, even fatal, adverse drug events also increases [3]. From a pharmacokinetics standpoint, drug-drug interactions occur when one drug-the perpetrator drug-alters the disposition of another co-administered drug-the victim drug.…”