Canadian Medication Appropriateness and Deprescribing Network, Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada.
Nantes Université, CHU Nantes, Pharmacie, Nantes, France.
J Am Geriatr Soc. 2024 Nov;72(11):3530-3540. doi: 10.1111/jgs.19164. Epub 2024 Sep 5.
Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.
This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation-adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.
Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).
While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed.
潜在不适当药物（PIMs）是指对特定个体而言，其危害可能超过益处的药物。尽管这些药物在老年人中被过度开具，但它们对医疗保健系统的直接成本却描述不足。
这是一项针对加拿大 65 岁及以上人群的 PIM 直接成本的横断面研究，使用了美国老年医学会的改编标准。我们检查了 2021 年国家处方药物利用信息系统的处方信息，并与 2013 年进行了比较。以加元（CAD）计算了 PIM 总年度支出的通胀调整后水平、每季度暴露的平均成本和 PIM 每季度暴露的平均水平。
除了加巴喷丁类药物、质子泵抑制剂和抗精神病药外，大多数类别的 PIM 暴露均有所下降，这三类药物均有所增加。2021 年，加拿大用于 PIM 的支出为 10 亿加元，与 2013 年的 15 亿加元相比下降了 33.6%。2021 年，最大的年度支出是质子泵抑制剂（2.11 亿加元）和加巴喷丁类药物（1.26 亿加元）。每暴露一人的 PIM 季度支出从 95 加元降至 57 加元。就人均平均成本而言，阿片类药物和抗精神病药最高（每人每次暴露分别为 138 加元和 118 加元）。由于 PIM 暴露的季度率观察到下降了 16.4%（从 2013 年的每 10000 人 7301 人降至 2021 年的每 10000 人 6106 人），因此可能发生了一些成本节约。
虽然加拿大的 PIM 支出有所下降，但总体成本仍然很高。一些严重有害类别的 PIM 处方量有所增加，因此需要采取有针对性的、可扩展的干预措施。
