Cost Outcomes of Potentially Inappropriate Prescribing (PIP) in Middle-Aged Adults: A Cross-Sectional Database Study

Problem

Potentially inappropriate prescribing (PIP) refers to non-evidence-based prescriptions that cause more harm than benefit. PIP commonly affects older adults (aged >65 years), within this age group, multimorbidity and polypharmacy are key drivers of PIP. Consequently, the link between PIP and adverse drug events (ADE) are well-known in older adults. Research suggests that polypharmacy and multimorbidity are also prevalent in middle-aged adults (45-64 years old).

Studies have used the PRescribing Optimally in Middle-aged People’s Treatments (PROMPT) criteria, estimate the prevalence of PIP in middle-aged adults (45-64 years old) to be around 18%, in this understudied age group.

In older adults, PIP has been shown to increase financial costs to the patient and healthcare system; due to PIP and ADEs (e.g. Hospital admission). There is limited research on PIP costs in middle-aged adults.

Aims and Objectives

This study aims to investigate the medication costs of PIP in middle-aged adults in South London general practices.

The primary objective is to calculate the drug cost for each of the 22 PROMPT criteria.

The secondary objectives are to:

Determine adequate alternative prescribing regimes for each of the 22 criteria and calculate each alternative’s medication cost.

Compare the medication costs of PIP vs adequate alternative prescribing.

Approach

This study is a retrospective cross-sectional study using primary data from Lambeth DataNet in South London. 

The population includes patients aged 45 to 64 years issued at least one prescription in each of the years 2014-2019 inclusive. 

National Institute for Health and Care Excellence (NICE) guidance was used to create adequate alternative prescribing regimes for each of the PROMPT criteria. The proposed alternative regimes will be validated by a panel of pharmacists, GPs and patients. The NHS Drug Tariff was used to cost PIP and adequate alternative prescribing.

Ethical approval has been provided for both this study and the use of a clinician and patient review panel.

Findings

At present, the adequate alternative regimes have been created and are awaiting review panel approval. Once this has been attained, data analysis will begin.

Consequences

Findings from this study will advocate for future research investigating a link between PIP and ADEs in middle-aged adults and the cost of ADEs. Moreover, it will provide critical information for a cost-benefit analysis of improved prescribing intervention design specific to middle-aged adults.

Implications for patients would be a reduction of PIP through improved clinician prescribing guidance; therefore, patients may be less at risk of ADE and increased hospital admissions, bettering their quality of life.