Polypharmacy Nearly Doubles Health Care Expenditures Among Older Patients With CVD

Substantial health care expenditures are associated with polypharmacy among older adults with cardiovascular diseases (CVD), according to findings of a cross-sectional study published in The American Journal of Cardiology.

Polypharmacy is defined as taking at least 5 medications at once, and CVD medications are among the most commonly prescribed treatments. Estimates have projected around 40% of older individuals are subjected to polypharmacy, while between 30% and 50% have been prescribed a potentially inappropriate medication.

Excessive polypharmacy at discharge has also been linked with worse outcomes among those hospitalized with acute decompensated heart failure. Adverse drug reactions and a decline in medication adherence is of particular concern among older patients.

Although older adults with CVD are known to have high rates of comorbidity and polypharmacy, a knowledge gap exists when it comes to this population’s economic impact.

Using data from the 2017 Medical Expenditure Panel Survey, researchers sought to estimate the association between health care expenditure and polypharmacy in older adults. All patients included had CVD and were at least 65 years old, while “the number of prescriptions was defined as the total number of distinct medications that the patient was prescribed during the survey year,” authors wrote.

To ascertain nonpharmacy-related expenditures, researchers subtracted pharmacy-related costs from patients’ total health care expenditures. High blood pressure, coronary heart disease, high cholesterol, and other conditions were among the comorbidities included in the analysis.

Authors also used Poisson regression to determine incidence rate ratios (IRRs); a total of 1610 (weighted total = 17,297,514 older adults) were included in analyses.

Researchers found:

• Polypharmacy was associated with increased total health care expenditure (IRR 1.98; 95% CI, 1.43 to 2.74), increased total pharmacy-related expenditure (IRR 2.87; 95% CI, 1.51 to 5.45), and increased nonpharmacy- related expenditure (IRR 1.78; 95% CI 1.26 to 2.52)
• After adjusting covariates, the expected average total health care expenditure for patients with polypharmacy was $19,068 (95% CI, 18,249 to 19,887) and $8,815 (95% CI, 8,544 to 9,086) without polypharmacy
• The expected average pharmacy-related expenditure in those with polypharmacy was $1,286 (95% CI, 1,221 to 1,351) and $488 (95% CI, 461 to 515) without polypharmacy
• The expected average nonpharmacy-related expenditure was $13,987 (95% CI, 13,413 to 14,562) for those with polypharmacy and $7,178 (95% CI, 6,903 to 7,454) for those without polypharmacy

Following adjustments for demographic and clinical factors, data showed polypharmacy “was associated with almost twice the total health care expenditure (198%) and 3 times for pharmacy expenditure (287%),” authors wrote.

Data included were nationally representative, although lack of sufficient follow-up for medication changes marks a limitation to the study. Because of its survey structure, under-reporting may have also taken place.

However, the study is the first to evaluate the economic impact of polypharmacy in this population and can serve as a foundation for future investigations to promote efficiency in health care, authors concluded.

Reference

Kwak MJ, Chang M, Chiadika S, et al. Healthcare expenditure associated with polypharmacy in older adults with cardiovascular diseases. Am J Cardiol. Published online February 12, 2022. doi:10.1016/j.amjcard.2022.01.012