Journal Article

Cost trends of potentially inappropriate medications among older adults between 2012 and 2021 in Quebec, Canada: a population-based repeated cross-sectional study

Guertin, Jason Robert, Gagnon, Marie-Eve, Cossette, Benoît, Gagnon, Magalie, Sirois, Caroline, Simard, Marc

2025

Overview

Background Potentially inappropriate medications (PIMs) are frequent in older adults, contributing to hospitalizations, adverse events, and healthcare burden. We aimed to estimate direct PIM cost trends from 2012 to 2021 among older women and men in Quebec, Canada. Methods Using medico-administrative data, we assessed direct costs paid by the public insurer (medication cost and professional fee, excluding out-of-pocket payments by individuals) of PIMs claimed by adults ≥65 years covered by the public drug plan. Costs for 16 PIM classes, identified using 2015 and 2019 Beers criteria, were calculated and stratified by sex and age group (65-74, 75-84, ≥85) for each fiscal year. We assessed the proportion of PIMs among all medication expenditures. We computed average costs/enrollee and usage prevalence for the costliest PIM classes. Trends were estimated using univariate linear regression with 95% confidence intervals. Results We found a non-statistically significant decrease in total PIM claim costs, from $206 million in 2012 to $186 million in 2021 (trend: -2.9[-17.4; 11.6]), representing 5.4% of medication expenditures for adults ≥65 in 2021. The reduction in total costs was more accentuated in women, whose annual costs were higher than those of men in all age groups. Average cost/enrollee decreased from $179 to $119 (trend: -7[-19; 5]), with a drop from $216 to $142 for women and $132 to $92 for men. Costs/enrollee were higher in 75-84 and ≥85 age groups. Costliest PIM classes included proton-pump inhibitors, benzodiazepines, antipsychotics, antidepressants, estrogens (women), and hypoglycemic agents (men). Cost trends did not always follow prevalence trends for these PIM classes. Conclusion PIM costs among older adults slightly decreased from 2012 to 2021. Appropriate prescribing and deprescribing appear crucial for reducing these costs. Further research should focus on estimating the societal impact and the cost-effectiveness analysis of deprescribing initiatives and other regulatory measures.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age / Age groups / Aged / Aged patients / Aged, 80 and over / Aging / Antidepressants / Antipsychotics / Benzodiazepines / Costs / Cross-Sectional Studies / Drug Costs - trends / Drug prices / Drug therapy / Drugs / Economic aspects / Estrogens / Expenditures / Female / Fiscal years / Geriatrics / Geriatrics/Gerontology / Health Expenditures - trends / Humans / Hypoglycemic agents / Inappropriate Prescribing - economics / Inappropriate Prescribing - trends / Male / Medical care, Cost of / Medication errors / Medicine / Medicine & Public Health / Nonsteroidal anti-inflammatory drugs / Older adults / Older people / Population studies / Population Surveillance - methods / Potentially inappropriate medication / Potentially Inappropriate Medication List - economics / Potentially Inappropriate Medication List - trends / Prescribing / Prescription drugs / Psychotropic drugs / Public expenditures / Quebec - epidemiology / Rehabilitation / Reimbursement / Risk factors / Statistical analysis / Statistics / Trend / Trends / Womens health