The Economic Burden of Inappropriate Drug Prescribing, Lack of Adherence and Compliance, Adverse Drug Events in Older People

Adverse drug events (ADEs) are an increasingly relevant issue for healthcare systems as they are associated with poorer health outcomes and avoidable misuse of resources. The rates of ADEs are higher in the elderly population, as many older patients have comorbidities, multiple drug prescriptions and deteriorated physical and cognitive functioning. The occurrence of ADEs can lead to a perceived lack of therapy efficacy and further underuse or suboptimal adherence in elderly people, with detrimental clinical outcomes. The present article systematically reviews the studies evaluating the economic impact of ADEs occurring as consequence of poor therapy adherence, inappropriate drug use, underuse of effective treatments and poor adherence, medication errors, drug-drug and drug-disease interactions.A Medline systematic literature review of studies evaluating the economic consequences of inappropriate drug prescribing, lack of adherence and compliance, ADEs in older people was performed. English-language articles were screened through a three-step approach (title review, abstract review, full article review) to select pertinent studies quantitatively evaluating costs. We systematically reviewed evidence from767 articles. After title, abstract and full text review, 21 articles were found to measure economic implications ofADEs, inappropriate drug prescribing and poor adherence in elderly patients. Studies suggested that the economic impact of these undesired effects is substantial: hospital costs were the main cost driver, with a relevant part of them being preventable (consequences of inappropriate prescribing). Healthcare costs for unused drug wastage and destruction were also surprisingly high.Although economic evidence in elderly patients is still limited, all studies seemed to confirm that the financial burden due to pharmacological treatment issues is relevant in elderly people. Including economic effects of adverse events in pharmacoeconomic analysis would be beneficial to improve the reliability of results. Preliminary evidence suggests that programmes aimed at comprehensively assessing geriatric conditions, detecting ‘high-risk’ prescriptions and training patients to comply with prescribed therapies could be costeffective measures to reduce the burden of ADEs.

[1]  J. L. Hidalgo,et al.  Factors associated with health care utilization by the elderly in a public health care system. , 2006, Health policy.

[2]  G. Lyman,et al.  Predicting individual risk of neutropenic complications in patients receiving cancer chemotherapy , 2011, Cancer.

[3]  Wolters Kluwer,et al.  Medication Non-Adherence in the Elderly: How Big is the Problem? , 2008 .

[4]  D. Rahelić,et al.  The incidence of potential drug–drug interactions in elderly patients with arterial hypertension , 2010, Pharmacy World & Science.

[5]  Y. Ouchi,et al.  High risk of adverse drug reactions in elderly patients taking six or more drugs: Analysis of inpatient database , 2012, Geriatrics & gerontology international.

[6]  I. Wilson,et al.  Prescription drug coverage and seniors: how well are states closing the gap? , 2002, Health affairs.

[7]  M. Volpe,et al.  The challenge of polypharmacy in cardiovascular medicine , 2010, Fundamental & clinical pharmacology.

[8]  M. Tinetti,et al.  Fall-risk evaluation and management: challenges in adopting geriatric care practices. , 2006, The Gerontologist.

[9]  Richard A Hirth,et al.  Increased spending on health care: long-term implications for the nation. , 2009, Health affairs.

[10]  B. V. Van Tassell,et al.  Medication nonadherence: an unrecognized cardiovascular risk factor. , 2007, MedGenMed : Medscape general medicine.

[11]  I. Imaz,et al.  Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis , 2010, Osteoporosis International.

[12]  Maria G. Frank.  Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults , 2008 .

[13]  C. Richards,et al.  Emergency hospitalizations for adverse drug events in older Americans. , 2011, The New England journal of medicine.

[14]  Susanne M. Smorenburg,et al.  PHARMACOEPIDEMIOLOGYAND PRESCRIPTION Recognition of adverse drug events in older hospitalized medical patients , 2012 .

[15]  Scott R. Smith,et al.  A medication self-management program to improve adherence to HIV therapy regimens. , 2003, Patient education and counseling.

[16]  K. Kuntz,et al.  Cost-effectiveness of inhaled steroids in asthma: impact of effect on bone mineral density. , 2006, The Journal of allergy and clinical immunology.

[17]  C. Wagner,et al.  Nature, Occurrence and Consequences of Medication-Related Adverse Events During Hospitalization , 2010, Drug safety.

[18]  D. Bates,et al.  Incidence and preventability of adverse drug events among older persons in the ambulatory setting. , 2003, JAMA.

[19]  P. Eckert,et al.  Antibiotic use: is appropriateness expensive? , 2009, The Journal of hospital infection.

[20]  L. Sera,et al.  Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy. , 2012, Clinics in geriatric medicine.

[21]  A. Burns.  Medication Therapy Management in community pharmacy practice: core elements of an MTM service (version 1.0). , 2005, Journal of the American Pharmacists Association : JAPhA.

[22]  A. Burns.  Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0). , 2008, Journal of the American Pharmacists Association : JAPhA.

[23]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. , 2009, Journal of clinical epidemiology.

[24]  J. Bainbridge,et al.  Challenges of Treatment Adherence in Older Patients with Parkinson’s Disease , 2009, Drugs & aging.

[25]  Eileen M. Crimmins,et al.  Change in disability-free life expectancy for Americans 70 years old and older* , 2009, Demography.

[26]  P. Davey,et al.  Cardiovascular prophylaxis with aspirin: costs of supply and management of upper gastrointestinal and renal toxicity. , 2003, British journal of clinical pharmacology.

[27]  H. Herwartz,et al.  The determinants of health-care expenditure: new results from semiparametric estimation. , 2009, Health economics.

[28]  M. Beers,et al.  Health outcomes associated with potentially inappropriate medication use in older adults. , 2008, Research in nursing & health.

[29]  A. Mark Fendrick,et al.  Potential economic impact of increasing low dose aspirin usage on CVD in the US , 2010, Current medical research and opinion.

[30]  C. Olofsson,et al.  Drugs up in smoke: a study of caseated drugs in Sweden , 1999, Pharmacy World and Science.

[31]  J. Rho,et al.  Counting the Costs of Drug-Related Adverse Events , 1999, PharmacoEconomics.

[32]  R. Campbell.  Recommendations for improving adherence to type 2 diabetes mellitus therapy--focus on optimizing insulin-based therapy. , 2012, The American journal of managed care.

[33]  P. Vaitkevicius,et al.  Under-Prescribing and Non-Adherence to Medications after Coronary Bypass Surgery in Older Adults , 2012, Drugs & Aging.

[34]  Ulrich Klotz,et al.  The clinical implications of ageing for rational drug therapy , 2008, European Journal of Clinical Pharmacology.

[35]  J. Benner,et al.  Predictors of Adherence to Concomitant Antihypertensive and Lipid-Lowering Medications in Older Adults , 2008, Drugs & aging.

[36]  K. Johnell,et al.  Inappropriate Drug Use in the Elderly: a Nationwide Register-Based Study , 2007, The Annals of pharmacotherapy.

[37]  J. Lauridsen,et al.  Ageing and health care expenditure in EU-15 , 2011, The European Journal of Health Economics.

[38]  Muhammad Mamdani,et al.  Adherence with statin therapy in elderly patients with and without acute coronary syndromes. , 2002, JAMA.

[39]  Ann F. Chou,et al.  The Effect of Adverse Medical Events on Spending on Inpatient Care , 2009, Quality management in health care.

[40]  Rune Dahlqvist,et al.  Adverse drug reactions as a cause for admissions to a department of internal medicine , 2002, Pharmacoepidemiology and drug safety.

[41]  E. D. Silveira,et al.  Resultados negativos asociados al uso de medicamentos que motivan ingreso hospitalario , 2011 .

[42]  David W Bates,et al.  The Costs Associated With Adverse Drug Events Among Older Adults in the Ambulatory Setting , 2005, Medical care.

[43]  Tejal K. Gandhi,et al.  Adverse drug events caused by serious medication administration errors , 2012, AMIA.

[44]  C. Hertogh,et al.  Exclusion of Older People from Clinical Trials , 2011, Drugs & aging.

[45]  F. Camacho,et al.  Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study. , 2003, Clinical therapeutics.

[46]  G. Onder,et al.  Medication errors in elderly people: contributing factors and future perspectives. , 2009, British journal of clinical pharmacology.

[47]  C. Hughes,et al.  Medication Non-Adherence in the Elderly , 2004, Drugs & aging.

[48]  A Haycox,et al.  The impact of non-compliance on the cost-effectiveness of pharmaceuticals: a review of the literature. , 2001, Health economics.

[49]  D. Pelclova,et al.  Medication errors—an enduring problem for children and elderly patients , 2012, Upsala journal of medical sciences.

[50]  J. Nickel.  BPH: costs and treatment outcomes. , 2006, The American journal of managed care.

[51]  Medication therapy management worth the effort , 2009 .

[52]  M. Grignon,et al.  Health expenditure growth: reassessing the threat of ageing. , 2006, Health economics.

[53]  K. Johnell,et al.  The Relationship between Number of Drugs and Potential Drug-Drug Interactions in the Elderly , 2007, Drug safety.

[54]  F. Haaijer-Ruskamp,et al.  Comparing Adverse Event Rates of Oral Blood Glucose-Lowering Drugs Reported by Patients and Healthcare Providers , 2011, Drug safety.

[55]  Sujuan Gao,et al.  Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. , 2012, The American journal of geriatric pharmacotherapy.

[56]  A. Haycox,et al.  Accounting for Noncompliance in Pharmacoeconomic Evaluations , 2012, PharmacoEconomics (Auckland).

[57]  P. Barry,et al.  Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland , 2009, Journal of clinical pharmacy and therapeutics.

[58]  C. Bell,et al.  Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments , 2012, Drug Safety.

[59]  Claudio Pedone,et al.  Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. , 2005, Archives of internal medicine.

[60]  D. Suh,et al.  Clinical and Economic Impact of Adverse Drug Reactions in Hospitalized Patients , 2000, The Annals of pharmacotherapy.

[61]  F. Camacho,et al.  Predictors of medication adherence and associated health care costs in an older population with overactive bladder syndrome: a longitudinal cohort study. , 2006, The Journal of urology.

[62]  J. Inadomi,et al.  Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. , 2010, The American journal of managed care.

[63]  T. B. Vicedo,et al.  Adverse Drug Reactions Which Provoke Hospital Admission , 2011 .

[64]  P. Fishman,et al.  Seniors with chronic health conditions and prescription drugs: benefits, wealth, and health. , 2004, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[65]  E. Roughead,et al.  Differential Impact of NSAIDs on Rate of Adverse Events that Require Hospitalization in High-Risk and General Veteran Populations , 2010, Drugs & aging.

[66]  Sonja Brajovic,et al.  Quality assessment of spontaneous triggered adverse event reports received by the Food and Drug Administration , 2012, Pharmacoepidemiology and drug safety.

[67]  W. Sanderson,et al.  The coming acceleration of global population ageing , 2008, Nature.

[68]  S. Doggrell,et al.  Adherence to Medicines in the Older-Aged with Chronic Conditions , 2010, Drugs & aging.

[69]  M. Litwin,et al.  Health care cost associated with prostate cancer, androgen deprivation therapy and bone complications. , 2006, The Journal of urology.

[70]  J. Avorn,et al.  The hidden cost of nonselective nonsteroidal antiinflammatory drugs in older patients. , 2003, The Journal of rheumatology.

[71]  H. Pols,et al.  Cost Effectiveness of Withdrawal of Fall-Risk-Increasing Drugs in Geriatric Outpatients , 2008, Drugs & aging.

[72]  A. Abu-Hanna,et al.  Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review , 2012, PloS one.

[73]  J. Sanford,et al.  Polymedicine and aging. Enhancing older adult care through advanced practitioners. GNPs and elder care pharmacists can help provide optimal pharmaceutical care. , 2007, Journal of gerontological nursing.