Suehs Brandon T, Davis Cralen, Ng Daniel B, Gooch Katherine
Comprehensive Health Insights, Inc, 515 West Market Street, 7th Floor, Louisville, KY, 40202, USA.
Astellas Pharma Global Development, Northbrook, IL, USA.
Drugs Aging. 2017 Jul;34(7):535-543. doi: 10.1007/s40266-017-0464-8.
Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality.
The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB).
A retrospective database analysis was conducted using a historical cohort design and including data collected between 2007 and 2013. Claims data were used to identify Medicare Advantage patients aged ≥65 years newly initiated on antimuscarinic OAB treatment. Patients were classified with potentially inappropriate use of antimuscarinic OAB drugs based on either the 2012 Beers Criteria or the 2015 Beers Criteria. Prevalence of PIM at the time of antimuscarinic initiation was determined. Bivariate comparisons of healthcare costs and medical condition burden were conducted to compare the marginal groups of patients (who qualified based on the 2012 Beers Criteria only or the 2015 Beers Criteria only). Differences in healthcare costs for patients with and without potentially inappropriate use of urinary antimuscarinics based on the 2012 and 2015 Beers Criteria were also examined.
Of 66,275 patients, overall prevalence of potentially inappropriate use of OAB antimuscarinics was higher using 2015 Beers Criteria than when using the 2012 Beers Criteria (25.0 vs. 20.6%). Dementia was the most common PIM-qualifying condition under both versions. The 2015 Beers Criteria identified more females, more White people, and a younger population with PIM. Comorbid medical condition burden was lower using the 2015 Beers Criteria. The 2015 Beers Criteria only group had lower median unadjusted healthcare costs ($7104 vs. 8301; p < 0.001). The incremental net cost associated with potentially inappropriate use of antimuscarinic medication was higher under the 2012 Beers Criteria than under the 2015 Beers Criteria.
In this cohort of patients newly initiated on antimuscarinic OAB treatment, substantial overlap of patients identified with PIM based on the 2015 Beers Criteria compared with the 2012 Beers Criteria was observed. In addition, the findings suggest that, when applied to antimuscarinic initiators, the 2015 Beers Criteria result in a greater prevalence of PIM and the identification of patients with less overall medical morbidity than the 2012 Beers Criteria.
研究表明，潜在不适当用药（PIM）在老年人中非常普遍，可能导致医疗费用增加、药物不良反应、住院和死亡。
本研究的目的是检验2015年对《Beers标准》的更新对与治疗膀胱过度活动症（OAB）的抗毒蕈碱药物潜在不适当使用相关的患病率和成本估计的影响。
采用回顾性数据库分析，采用历史队列设计，纳入2007年至2013年收集的数据。索赔数据用于识别年龄≥65岁新开始抗毒蕈碱OAB治疗的医疗保险优势患者。根据2012年《Beers标准》或2015年《Beers标准》，将患者分类为抗毒蕈碱OAB药物的潜在不适当使用。确定抗毒蕈碱药物开始使用时PIM的患病率。对医疗费用和医疗状况负担进行双变量比较，以比较边缘患者组（仅根据2012年《Beers标准》或仅根据2015年《Beers标准》符合条件的患者）。还检查了根据2012年和2015年《Beers标准》有或无潜在不适当使用尿抗毒蕈碱药物的患者的医疗费用差异。
在66275名患者中，使用2015年《Beers标准》时，OAB抗毒蕈碱药物潜在不适当使用的总体患病率高于使用2012年《Beers标准》时（25.0%对20.6%）。痴呆是两个版本中最常见的符合PIM条件的疾病。2015年《Beers标准》识别出更多女性、更多白人以及更年轻的PIM患者群体。使用2015年《Beers标准》时，合并症医疗状况负担较低。2015年《Beers标准》仅适用组的未调整医疗费用中位数较低（7104美元对8301美元；p<0.001）。2012年《Beers标准》下与抗毒蕈碱药物潜在不适当使用相关的增量净成本高于2015年《Beers标准》。
在这组新开始抗毒蕈碱OAB治疗的患者中，观察到基于2015年《Beers标准》与2012年《Beers标准》识别出的PIM患者有大量重叠。此外，研究结果表明，当应用于抗毒蕈碱药物起始者时，2015年《Beers标准》导致PIM的患病率更高，并且与2012年《Beers标准》相比，识别出的总体医疗发病率较低的患者更多。
