gms | German Medical Science

Background: Some drugs carry an increased risk for adverse effects or loss of efficacy in elderly patients. Accordingly, lists of inappropriate medication (PIM) that should be avoided in elderly patients have been proposed. In 2010 an expert panel generated a PIM list adapted to the German drug market (PRISCUS list) which lists 83 inappropriate agents and their recommended surrogates. The objective of the study is to calculate the amount of drug reimbursement according to the PRISCUS-list from the perspective of the statutory health insurance (SHI). We further evaluate the potential savings using appropriate surrogates.

Materials and Methods: The underlying data were provided by AOK Research Institute (WIdO). The study material is a register extraction of top 30 drugs (by sales volume) on PRISCUS-list in 2009 exclusively for patients ≥65 years of the entire SHI-population. We calculated the percentage of sales and defined daily dose (DDD) for patients ≥65 compared to the total SHI-population. Costs for the recommended substitution by presumably safer alternative drugs were determined by applying minimal and maximal price scenario in case that different drugs were available. Furthermore, we compared our results with international studies.

Results: In 2009, the proportion of the 30 drugs on the PRISCUS-list that were prescribed to patients ≥65 was 63.8%. Drugs with the largest proportion of DDD prescribed to patients ≥65 were Sotalol (92.9%), Acetyldigoxin (89.3%) and Piracetam (88.8%). Drug reimbursement for the top 30 PIM medications prescribed to patients ≥65 were € 305.6 million, total sales regarding the entire population were € 505.5 million. Thus, almost 54.3% of sales were prescribed to patients ≥65. Reimbursement for Solifenacin was highest with € 32.5 million, followed by Etoricoxib (€ 30.6 million) and Zopiclon (€ 21.5 million). When prescribing the most expensive surrogates, costs for medications raise up to € 1,154.7 million. In contrast, when applying the least expensive surrogates, costs decrease to € 236.3 million.

Conclusion: Most prescriptions of drugs from the PRISCUS list are actually made to patients ≥65, in whom these drugs should be avoided. The economic impact of prescribing presumably safer alternatives instead of PIM depends largely on which of several alternative drugs is chosen. Future studies should also incorporate costs of adverse drug events when calculating the economic consequences.