PMID- 30705233
OWN - NLM
STAT- MEDLINE
DCOM- 20200115
LR  - 20200309
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 9
IP  - 1
DP  - 2019 Jan 30
TI  - Economic impact of potentially inappropriate prescribing and related adverse 
      events in older people: a cost-utility analysis using Markov models.
PG  - e021832
LID - 10.1136/bmjopen-2018-021832 [doi]
LID - e021832
AB  - OBJECTIVES: To determine the economic impact of three drugs commonly involved in 
      potentially inappropriate prescribing (PIP) in adults aged >/=65 years, including 
      their adverse effects (AEs): long-term use of non-steroidal anti-inflammatory 
      drugs (NSAIDs), benzodiazepines and proton pump inhibitors (PPIs) at maximal 
      dose; to assess cost-effectiveness of potential interventions to reduce PIP of 
      each drug. DESIGN: Cost-utility analysis. We developed Markov models 
      incorporating the AEs of each PIP, populated with published estimates of 
      probabilities, health system costs (in 2014 euro) and utilities. PARTICIPANTS: A 
      hypothetical cohort of 65 year olds analysed over 35 1-year cycles with 
      discounting at 5% per year. OUTCOME MEASURES: Incremental cost, quality-adjusted 
      life years (QALYs) and incremental cost-effectiveness ratios with 95% credible 
      intervals (CIs, generated in probabilistic sensitivity analysis) between each PIP 
      and an appropriate alternative strategy. Models were then used to evaluate the 
      cost-effectiveness of potential interventions to reduce PIP for each of the three 
      drug classes. RESULTS: All three PIP drugs and their AEs are associated with 
      greater cost and fewer QALYs compared with alternatives. The largest reduction in 
      QALYs and incremental cost was for benzodiazepines compared with no sedative 
      medication (euro3470, 95% CI euro2434 to euro5001; -0.07 QALYs, 95% CI -0.089 to -0.047), 
      followed by NSAIDs relative to paracetamol (euro806, 95% CI euro415 and euro1346; -0.07 
      QALYs, 95% CI -0.131 to -0.026), and maximal dose PPIs compared with maintenance 
      dose PPIs (euro989, 95% CI -euro69 and euro2127; -0.01 QALYs, 95% CI -0.029 to 0.003). For 
      interventions to reduce PIP, at a willingness-to-pay of euro45 000 per QALY, 
      targeting NSAIDs would be cost-effective up to the highest intervention cost per 
      person of euro1971. For benzodiazepine and PPI interventions, the equivalent cost 
      was euro1480 and euro831, respectively. CONCLUSIONS: Long-term benzodiazepine and NSAID 
      prescribing are associated with significantly increased costs and reduced QALYs. 
      Targeting inappropriate NSAID prescribing appears to be the most cost-effective 
      PIP intervention.
CI  - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Moriarty, Frank
AU  - Moriarty F
AUID- ORCID: 0000-0001-9838-3625
AD  - HRB Centre for Primary Care Research, Department of General Practice, Royal 
      College of Surgeons in Ireland, Dublin, Ireland.
FAU - Cahir, Caitriona
AU  - Cahir C
AD  - Division of Population Health Sciences, Royal College of Surgeons in Ireland, 
      Dublin, Ireland.
FAU - Bennett, Kathleen
AU  - Bennett K
AD  - Division of Population Health Sciences, Royal College of Surgeons in Ireland, 
      Dublin, Ireland.
FAU - Fahey, Tom
AU  - Fahey T
AUID- ORCID: 0000-0002-5896-5783
AD  - HRB Centre for Primary Care Research, Department of General Practice, Royal 
      College of Surgeons in Ireland, Dublin, Ireland.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190130
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Proton Pump Inhibitors)
RN  - 12794-10-4 (Benzodiazepines)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects/economics
MH  - Benzodiazepines/adverse effects/economics
MH  - Cohort Studies
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Humans
MH  - Inappropriate Prescribing/*economics/*prevention & control
MH  - Male
MH  - Markov Chains
MH  - Medication Therapy Management/organization & administration
MH  - Models, Economic
MH  - Practice Patterns, Physicians'/economics/*organization & administration
MH  - Primary Health Care/economics/*organization & administration
MH  - Proton Pump Inhibitors/adverse effects/economics
MH  - Quality-Adjusted Life Years
PMC - PMC6359741
OTO - NOTNLM
OT  - appropriateness
OT  - economic evaluation
OT  - elderly
OT  - medications
OT  - stopp
COIS- Competing interests: None declared.
EDAT- 2019/02/02 06:00
MHDA- 2020/01/16 06:00
PMCR- 2019/01/30
CRDT- 2019/02/02 06:00
PHST- 2019/02/02 06:00 [entrez]
PHST- 2019/02/02 06:00 [pubmed]
PHST- 2020/01/16 06:00 [medline]
PHST- 2019/01/30 00:00 [pmc-release]
AID - bmjopen-2018-021832 [pii]
AID - 10.1136/bmjopen-2018-021832 [doi]
PST - epublish
SO  - BMJ Open. 2019 Jan 30;9(1):e021832. doi: 10.1136/bmjopen-2018-021832.