ArticleBMJ open2019
Economic impact of potentially inappropriate prescribing and related adverse events in older people: a cost-utility analysis using Markov models.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 5 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- Deprescribing Interventions in Older Adults with Polypharmacy: A Systematic Review of Economic Evaluations.Applied health economics and health policy · 2026Pooled it
- Effective deprescribing strategies for reducing potentially inappropriate medications and improving economic outcomes in community-based settings: a systematic review and meta-analysis.BMC health services research · 2026Pooled it
- Economic models of community-based falls prevention: a systematic review with subsequent commissioning and methodological recommendations.BMC health services research · 2022Pooled it
- Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations.PharmacoEconomics · 2022Pooled it
- Economic Evaluations of Interventions to Optimize Medication Use in Older Adults with Polypharmacy and Multimorbidity: A Systematic Review.Clinical interventions in aging · 2021Pooled it
- Cost-effectiveness of a structured medication review approach for multimorbid older adults: Within-trial analysis of the OPERAM study.PloS one · 2022Trial
- Economic, cultural and social inequalities in potentially inappropriate medication-An Austrian perspective.Wiener klinische Wochenschrift · 2026Article
- The risk and cost of drug-drug interactions in an older population acutely admitted to hospital in Ireland.International journal of clinical pharmacy · 2025Article
- Supplementary Treatment for Alleviating Pain and Enhancing Functional Ability in Geriatric Patients with Osteoarthritis.Healthcare (Basel, Switzerland) · 2025Article
- Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals.Drug safety · 2024Article
- Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort.European geriatric medicine · 2024Observational
- Estimating the economic effect of harm associated with high risk prescribing of oral non-steroidal anti-inflammatory drugs in England: population based cohort and economic modelling study.BMJ (Clinical research ed.) · 2024Article
- A new curricular framework for an interprofessional approach to deprescribing: Why and how pharmacists should lead the way.Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC · 2024Article
- Article
- Potentially inappropriate prescribing in polymedicated older adults with atrial fibrillation and multimorbidity: a Swedish national register-based cohort study.Frontiers in pharmacology · 2024Article
- Investigating the impact of a pharmacist intervention on inappropriate prescribing practices at hospital admission and discharge in older patients: a secondary outcome analysis from a randomized controlled trial.Therapeutic advances in drug safety · 2024Article
- Proton pump inhibitors in inpatients: Are we getting it right? A retrospective analysis.Qatar medical journal · 2024Article
- Value assessment of deprescribing interventions: Suggestions for improvement.Journal of the American Geriatrics Society · 2023Article
- A Proposed Curricular Framework for an Interprofessional Approach to Deprescribing.Medical science educator · 2023Article
- Healthcare costs of adverse drug reactions and potentially inappropriate prescribing in older adults: a population-based study.BMJ open · 2022Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine the economic impact of three drugs commonly involved in potentially inappropriate prescribing (PIP) in adults aged ≥65 years, including their adverse effects (AEs): long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines and proton pump inhibitors (PPIs) at maximal dose; to assess cost-effectiveness of potential interventions to reduce PIP of each drug.
designCost-utility analysis. We developed Markov models incorporating the AEs of each PIP, populated with published estimates of probabilities, health system costs (in 2014 euro) and utilities.
participantsA hypothetical cohort of 65 year olds analysed over 35 1-year cycles with discounting at 5% per year. OUTCOME MEASURES: Incremental cost, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios with 95% credible intervals (CIs, generated in probabilistic sensitivity analysis) between each PIP and an appropriate alternative strategy. Models were then used to evaluate the cost-effectiveness of potential interventions to reduce PIP for each of the three drug classes.
resultsAll three PIP drugs and their AEs are associated with greater cost and fewer QALYs compared with alternatives. The largest reduction in QALYs and incremental cost was for benzodiazepines compared with no sedative medication (€3470, 95% CI €2434 to €5001; -0.07 QALYs, 95% CI -0.089 to -0.047), followed by NSAIDs relative to paracetamol (€806, 95% CI €415 and €1346; -0.07 QALYs, 95% CI -0.131 to -0.026), and maximal dose PPIs compared with maintenance dose PPIs (€989, 95% CI -€69 and €2127; -0.01 QALYs, 95% CI -0.029 to 0.003). For interventions to reduce PIP, at a willingness-to-pay of €45 000 per QALY, targeting NSAIDs would be cost-effective up to the highest intervention cost per person of €1971. For benzodiazepine and PPI interventions, the equivalent cost was €1480 and €831, respectively.
conclusionsLong-term benzodiazepine and NSAID prescribing are associated with significantly increased costs and reduced QALYs. Targeting inappropriate NSAID prescribing appears to be the most cost-effective PIP intervention.
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Registered trials
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