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The association of potentially inappropriate medication use on health outcomes and hospital costs in community-dwelling older persons: a longitudinal 12-year study

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Abstract

Aims

To determine (1) whether potentially inappropriate medication (PIM) use defined by the Meds75 + database is associated with fracture-specific hospitalisations and all-cause mortality, and (2) the association between PIM use and all-cause hospitalisation costs in a 12-year follow-up of a nationwide sample of people aged ≥ 65 years in Finland.

Methods

This is a longitudinal study of 20,666 community-dwelling older persons with no prior purchases of PIMs within a 2-year period preceding the index date (1 Jan 2002), who were followed until the end of 2013. Data were obtained from the Finnish Prescription Register, and it was accompanied by information on inpatient care, causes of deaths and socioeconomic status from other national registers. Propensity score matching (PSM) analysis was used to account for potential selection effect in PIM use. Cox proportional hazards regression was used to identify the time to the first fracture or death by comparing PIM-users (n = 10,333) with non-users (n = 10,333). The association between PIM use and hospital costs was analysed with a fixed effects linear model.

Results

PIM use was weakly associated with an increased risk of fractures and death. The association was stronger in the first PIM-use periods. Hospitalised PIM-users had 15% higher hospital costs compared to non-users during the 12-year follow-up.

Conclusion

PIM initiation was associated with an increased risk of fracture-specific hospitalisation and mortality and PIM-users had higher hospital costs than non-users. Health care providers should carefully consider these issues when prescribing PIM for older persons.

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Acknowledgements

The authors want to thank The Social Insurance Institution (SII) of Finland for funding this study, and Statistics Finland’s Research Services for offering the data via remote access service.

Funding

This study was funded by The Social Insurance Institution of Finland (Grant number 15/26/2015).

Author information

Authors and Affiliations

  1. Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland

    Virva Hyttinen, Anna-Kaisa Vartiainen & Hannu Valtonen

  2. Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland

    Johanna Jyrkkä

  3. Kela Research, The Social Insurance Institution, Helsinki, Finland

    Leena K. Saastamoinen

Authors
  1. Virva Hyttinen
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  2. Johanna Jyrkkä
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  3. Leena K. Saastamoinen
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  4. Anna-Kaisa Vartiainen
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Correspondence to Virva Hyttinen.

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Hyttinen, V., Jyrkkä, J., Saastamoinen, L.K. et al. The association of potentially inappropriate medication use on health outcomes and hospital costs in community-dwelling older persons: a longitudinal 12-year study. Eur J Health Econ 20, 233–243 (2019). https://doi.org/10.1007/s10198-018-0992-0

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