Article
Drug-related problems increase healthcare costs for people living with dementia
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Authors
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Bernhard Michalowsky
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE) e.V., Versorgungsepidemiologie und Community Health, Greifswald, Germany
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Anne Wohlgemuth
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Standort Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Germany
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Diana Wucherer
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Standort Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Germany
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Anika Kaczynski
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Standort Rostock/Greifswald, Translationale Versorgungsforschung, Greifswald, Germany
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Rene Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Standort Rostock/Greifswald, Interventionelle Versorgungsforschung, Greifswald, Germany
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Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Versorgungsepidemiologie und Community Health, Greifswald, Germany
| Published: | October 2, 2019 |
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Outline
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Background: Drug-related problems (DRP) are common in the elderly population, especially in people living with dementia (PWD). DRP are associated with adverse outcomes that could result in increased costs. The objective of the study was to analyze the association between DRP and healthcare costs in PWD.
Methods: The analysis was based on the cross-sectional data of the DelpHi trial (Dementia: Life- and person-centered help) and 424 PWD. Prescribed and over-the-counter drugs taken as well as compliance, adverse effects and drug administration were assessed at the PWD´s homes during an extensive medication review. DRP were identified and classified by pharmacists using an adapted German version of “PIE-Doc®”. Healthcare utilization was assessed retrospectively using standardized and computer-assisted face to face interviews with the participants, their caregivers, and service stuff. Healthcare costs were calculated using standardized unit costs, representing cost from the public payers’ perspective. The associations between DRP and healthcare costs were analyzed using multiple linear regression models.
Results: 93% of the participants had at least one DRP. An inappropriate drug choice was significantly associated with higher total costs (b=2,718.10€; CI95% 1,448.06 to 3,988.15). This was due to significantly higher costs for hospitalization (b=1,936.21€; 670.02 -3,202.40) and for medication (b=417.04€; 68.78 to 765.30). Problems with medication dosage and drug interaction were as well significantly associated with higher medication costs (b=679.80€; 31.41 to 1,328.18; and b=630.36€; 259.68 to 1,001.05, respectively). Contrary to this, formal care costs significantly decreased with a higher number of adverse drug events (b=-1,022.43€; -1,893.65 to -151.20).
Conclusions: An inappropriate drug choice, problems with the dosage and with drug interaction could significantly lead to higher cost for healthcare payers. Those problems are manageable to a certain extent using medication management. However, further research is needed to clarify how DRP could efficiently be avoided, saving already scarce healthcare resources.
