Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, PO Box 9510, Morgantown, West, Virginia 26505, USA.
Department of Clinical Pharmacy, West Virginia University, School of Pharmacy, PO Box 9510, Morgantown, West, Virginia 26505, USA.
J Geriatr Oncol. 2019 Sep;10(5):698-704. doi: 10.1016/j.jgo.2019.01.012. Epub 2019 Feb 13.
To assess the association between Potentially Inappropriate Medication (PIM) use and healthcare utilization and costs among Medicare beneficiaries with breast, prostate, or colorectal cancer.
A retrospective cohort study was conducted using the SEER-Medicare linked database in older adults with breast (N = 17,630), prostate (N = 18,721), or colorectal cancer (female: N = 5652; male: N = 3768). PIM use was defined based on 2015 Beers Criteria and was measured using prescription claims. Count models were used to examine the association between PIM use and the number of inpatient and ER visits. Generalized linear models were utilized with the log-link function and gamma distribution to analyze associations between PIM use and medical expenditures. The Inverse Treatment Probability Treatment Weights were applied in the analyses.
61.7% of patients with breast cancer, 47.3% of patients with prostate cancer, and 66.3% (females: 68.0%; males: 63.8%) of patients with colorectal cancer were found to use one or more PIM. PIM use was positively associated with number of inpatient visits, number of ER visits, non-drug costs, and total medical costs in all three types of cancer, except for the number of inpatient visits among patients with colorectal cancer.
PIM use was significantly associated with greater healthcare utilization and higher healthcare costs in this population. Future research should be undertaken to obtain additional evidence that can aid in the optimization of integrated interdisciplinary programs to facilitate effective management of care for older patients with cancer and other co-morbid medical problems.
评估潜在不适当药物（PIM）使用与医疗保险受益人群中患有乳腺癌、前列腺癌或结直肠癌患者的医疗保健利用和成本之间的关系。
使用 SEER-Medicare 关联数据库，对 17630 名患有乳腺癌、18721 名患有前列腺癌或 5652 名女性和 3768 名男性患有结直肠癌的老年人进行回顾性队列研究。根据 2015 年 Beers 标准定义 PIM 使用，并使用处方索赔进行测量。计数模型用于检查 PIM 使用与住院和急诊就诊次数之间的关联。使用广义线性模型和对数链接函数和伽马分布分析 PIM 使用与医疗支出之间的关联。在分析中应用了逆处理概率处理权重。
61.7%的乳腺癌患者、47.3%的前列腺癌患者和 66.3%（女性：68.0%；男性：63.8%）的结直肠癌患者被发现使用一种或多种 PIM。除了结直肠癌患者的住院就诊次数外，PIM 使用与所有三种癌症的住院就诊次数、急诊就诊次数、非药物成本和总医疗成本呈正相关。
在该人群中，PIM 使用与更高的医疗保健利用率和更高的医疗保健成本显著相关。未来的研究应该进行，以获得更多的证据，帮助优化综合多学科计划，促进对患有癌症和其他合并医疗问题的老年患者的护理的有效管理。
