The Costs of Benzodiazepine-Associated Hospital-Treated Fall Injuries in the EU: A Pharmo Study

Abstract

Objective

To estimate the hospitalisation costs of accidental fall injuries in the EU resulting from the use of benzodiazepines.

Methods

Risk and exposure data were obtained from the Dutch Pharmo system, a population-based register of drug-dispensing records and hospital records. The population attributable risk (PAR) was calculated using the age-specific prevalence estimates of benzodiazepine use and the corresponding relative risk (RR), obtained from a case-control study in community-dwelling inhabitants over 55 years of age in defined areas of The Netherlands covering the period 1985–2000. Annual hospitalisation costs of benzodiazepine-related fall injuries were based on the age-specific PARs and extrapolated to the European population using accident and demographic data of the EU. All analyses were performed from the perspective of a third-party payer.

Results

Fall injuries in the study population were significantly associated with benzodiazepine use (RR 1.6, 95% CI 1.4–1.7), especially in those aged over 85 years (RR 3.6, 95% CI 2.9–4.5). The total annual hospital direct medical costs in 2000 of fall-related injuries attributable to benzodiazepine use were €1.8 billion (95% CI €1.5-2.2 billion) in the EU.

Conclusions

The estimated costs of hospitalisations of accidental-fall injuries related to benzodiazepine use in the EU varied between €1.5 and €2.2 billion each year. More than 90% of these costs were in the elderly, with hip fractures as the major contributor. Discontinuing benzodiazepines in the elderly and/or substituting them with other drugs not associated with the risk of falls in the elderly will to a large extent prevent these accidents.

This is a preview of subscription content, access via your institution.

Table I
Table II
Fig. 1
Table III
Table IV

References

  1. 1.

    Herings RM, Stricker BH, de Boer A, et al. Benzodiazepines and the risk of falling leading to femur fractures: dosage more important than elimination half-life. Arch Intern Med 1995; 155(16): 1801–7

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Neutel CI, Perry S, Maxwell C. Medication use and risk of falls. Pharmacoepidemiol Drug Saf 2002; 11(2): 97–104

    PubMed  Article  Google Scholar 

  3. 3.

    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropoic drugs. J Am Geriatr Soc 1999; 47(1): 30–9

    PubMed  CAS  Google Scholar 

  4. 4.

    Lindsay R. The burden of osteoporosis: cost. Am J Med 1995; 98(2A): 9S–11S

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Dolan P, Torgerson DJ. The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 1998; 8(6): 611–7

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Ray NF, Chan JK, Thamer M, et al. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12(1): 24–35

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Johnell O. The socioeconomic burden of fractures: today and in the 21st century. Am J Med 1997; 103(2A): 20S–5S

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Koeck CM, Schwappach DL, Niemann FM, et al. Incidence and costs of osteoporosis-associated hip fractures in Austria. Wien Klin Wochenschr 2001; 113(10): 371–7

    PubMed  CAS  Google Scholar 

  9. 9.

    Reginster JY, Gillet P, Ben Sedrine W, et al. Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics 1999; 15(5): 507–14

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Herings RM, Klungel OH. An epidemiological approach to assess the economic burden of NSAID-induced gastrointestinal events in The Netherlands. Pharmacoeconomics 2001; 19(6): 655–65

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Coughlin SS, Benichou J, Weed DL. Attributable risk estimation in case-control studies. Epidemiol Rev 1994; 16(1): 51–64

    PubMed  CAS  Google Scholar 

  12. 12.

    Herings RMC. PHARMO: a record linkage system for postmarketing surveillance of prescription drugs in The Netherlands [Doctorate]. Utrecht: Utrecht University, 1993

    Google Scholar 

  13. 13.

    Paas GRA, Veenhuizen KCW. Onderzoek naar de betrouwbaarheid van de Landelijke Medische Registratie (LMR). Utrecht: Prismant, 2001

    Google Scholar 

  14. 14.

    Mantel-Teeuwisse AK, Klungel OH, Verschuren WM, et al. Comparison of different methods to estimate prevalence o drug use by using pharmacy records. J Clin Epidemiol 2001; 54(11): 1181–6

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Miettinen OS. Theoretical epidemiology. Montreal: John Wiley & Sons Inc, 1985

    Google Scholar 

  16. 16.

    OECD. OECD Health Data 2001. Paris: OECD Paris Centre, 2001

    Google Scholar 

  17. 17.

    Logistic regression examples using the SAS system. Version 6. Cary (NC), USA: SAS Institute Inc, 1995

  18. 18.

    Lord SR, Anstey KJ, Williams P, et al. Psychoactive medication use, sensori-motor function and falls in older women. Br J Clin Pharmacol 1995; 39(3): 227–34

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Ray WA, Griffin MR, Downey W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA 1989; 262(23): 3303–7

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Gorgels WJ, Oude Voshaar RC, Mol AJ, et al. [Long-term use of benzodiazepines]. Ned Tijdschr Geneeskd 2001; 145(28): 1342–6

    PubMed  CAS  Google Scholar 

  21. 21.

    Bakker A. Drug use in the Netherlands, an introduction. In: Bakker A, Hekster YA, Leufkens HG, editors. Drug consumption in the Netherlands. Maarssen: Brocacef, 1991: 6–9

    Google Scholar 

  22. 22.

    Boereboom FTJ, Raymakers JA, De Groot RRM, et al. Epidemiology of hip fractures in the Netherlands: women compared to men. Osteoporos Int 1992; 2: 279–84

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Kannus P, Niemi S, Parkkari J, et al. Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 1999; 353(9155): 802–5

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Mazzuoli GF, Gennari C, Passed M, et al. Hip fracture in Italy: epidemiology and preventive efficacy of bone-active drugs. Bone 1993; 14Suppl. 1: S81–4

    PubMed  Article  Google Scholar 

  25. 25.

    Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med 1997; 157(14): 1531–6

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank all pharmacists, medical specialists and staff members of the hospitals participating in the Pharmo system.

This study was supported by an unrestricted grant from Pfizer International, New York, USA.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Wim G. Goettsch.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Panneman, M.J.M., Goettsch, W.G., Kramarz, P. et al. The Costs of Benzodiazepine-Associated Hospital-Treated Fall Injuries in the EU: A Pharmo Study. Drugs Aging 20, 833–839 (2003). https://doi.org/10.2165/00002512-200320110-00004

Download citation

Keywords

  • Community Pharmacy
  • Population Attributable Risk
  • Total Treatment Cost
  • Hospital Discharge Record
  • Fall Injury