PIMs usage among elderly patients may increase adverse events and health care costs

Jan 13 2010

A new study provides important evidence that the use of certain potentially inappropriate medications (PIMs) among the elderly may increase adverse events and health care costs.

“This study confirms that elderly patients who are prescribed PIMs tend to be higher utilizers of health care resources than patients who don’t take them”

Among the key study findings was that patients receiving sedative hypnotics (classified as Beers high-severity, or BHS) were significantly more likely (22 percent) to suffer a fall or fracture than control subjects. In addition, patients exposed to these medications had significantly higher adjusted medical and total health care costs than those in the control group ($20,537 vs. $15,835 for adjusted medical costs and $21,807 vs. $17,154 for adjusted total health care costs; P<.001 for both).

Clinicians and managed care organizations use specific measures, based on the Beers criteria, to help identify and target elderly patients who may be at risk of adverse events due to their use of PIMs. While the Beers criteria are widely used, there has been very limited data on clinical outcomes associated with specific PIMs.

Sedative-hypnotics are drugs that depress or slow down the body's functions and are often prescribed to treat anxiety or promote sleep. Some well-known drugs in this category include diazepam (Valium) and secobarbital (Seconal).

The study, published in the January edition of The American Journal of Managed Care, is the first to examine clinical outcomes associated with specific so-called PIMs and is based on electronic pharmacy and medical claims data. It was conducted by Prescription Solutions, a leading pharmacy benefits management organization and a UnitedHealth Group (NYSE: UNH) company.

“These findings demonstrate that elderly patients who take certain PIMs are at increased risk of adverse events and higher health care costs,” said Karen Stockl, Pharm.D., Prescription Solutions, and lead author of the study. “This should be of great value to managed care organizations that are conducting, or deciding whether to conduct, clinical programs to reduce PIMs in this vulnerable patient population.”

Study Reveals Unexpected Finding

In an unexpected finding, patients receiving BHS anticholinergics did not have a higher risk of delirium or hallucinations than the control group. Anticholinergic medications are widely used to treat a variety of disorders commonly found in elderly populations, such as gastrointestinal disorders, respiratory disorders, motion sickness, muscular spasms and Parkinson’s disease, and as an aid to anesthesia.

Considering the large study sample size (37,358 pairs), the fact that there was no higher risk for the anticholinergic group was a surprising outcome. The researchers postulated that the way patients actually take these medications in a real-world setting (e.g., intermittently or at low doses) may minimize the number of observed events. Another possible explanation is that delirium and hallucinations may be overlooked by patients or their caregivers and may never be reported to the physician. Finally, delirium and hallucinations may be under-recognized or under-coded in the claims database.

Medical Costs Higher For Patients Exposed to PIMs

Whether adverse events were higher for exposed patients or not, one finding was the same for all PIM categories: medical costs were significantly higher for patients exposed to the PIMs than for control subjects.

“This study confirms that elderly patients who are prescribed PIMs tend to be higher utilizers of health care resources than patients who don’t take them,” said Dr. Joseph Addiego, chief medical officer, Prescription Solutions. “Studies such as this are critically important to the health care industry because they provide a real-world look at drug utilization and its impact on clinical outcomes and health care costs.”