Skip to main content
SpringerLink
Log in

Impact of 2015 Update to the Beers Criteria on Estimates of Prevalence and Costs Associated with Potentially Inappropriate Use of Antimuscarinics for Overactive Bladder

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality.

Objectives

The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB).

Methods

A retrospective database analysis was conducted using a historical cohort design and including data collected between 2007 and 2013. Claims data were used to identify Medicare Advantage patients aged ≥65 years newly initiated on antimuscarinic OAB treatment. Patients were classified with potentially inappropriate use of antimuscarinic OAB drugs based on either the 2012 Beers Criteria or the 2015 Beers Criteria. Prevalence of PIM at the time of antimuscarinic initiation was determined. Bivariate comparisons of healthcare costs and medical condition burden were conducted to compare the marginal groups of patients (who qualified based on the 2012 Beers Criteria only or the 2015 Beers Criteria only). Differences in healthcare costs for patients with and without potentially inappropriate use of urinary antimuscarinics based on the 2012 and 2015 Beers Criteria were also examined.

Results

Of 66,275 patients, overall prevalence of potentially inappropriate use of OAB antimuscarinics was higher using 2015 Beers Criteria than when using the 2012 Beers Criteria (25.0 vs. 20.6%). Dementia was the most common PIM-qualifying condition under both versions. The 2015 Beers Criteria identified more females, more White people, and a younger population with PIM. Comorbid medical condition burden was lower using the 2015 Beers Criteria. The 2015 Beers Criteria only group had lower median unadjusted healthcare costs ($7104 vs. 8301; p < 0.001). The incremental net cost associated with potentially inappropriate use of antimuscarinic medication was higher under the 2012 Beers Criteria than under the 2015 Beers Criteria.

Conclusions

In this cohort of patients newly initiated on antimuscarinic OAB treatment, substantial overlap of patients identified with PIM based on the 2015 Beers Criteria compared with the 2012 Beers Criteria was observed. In addition, the findings suggest that, when applied to antimuscarinic initiators, the 2015 Beers Criteria result in a greater prevalence of PIM and the identification of patients with less overall medical morbidity than the 2012 Beers Criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Stockl KM, Le L, Zhang S, Harada AS. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 2010;16(1):e1–10.

    PubMed  Google Scholar 

  2. Curtis LH, Ostbye T, Sendersky V, Hutchison S, Dans PE, Wright A, et al. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Int Med. 2004;164(15):1621.

    Article  Google Scholar 

  3. Hamano J, Tokuda Y. Inappropriate prescribing among elderly home care patients in Japan: prevalence and risk factors. J Prim Care Comm Health. 2014;5(2):90–6. doi:10.1177/2150131913518346.

    Article  Google Scholar 

  4. Pasina L, Djade CD, Tettamanti M, Franchi C, Salerno F, Corrao S, et al. Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI Study. J Clin Pharm Ther. 2014;21(10):12178.

    Google Scholar 

  5. Yasein NA, Barghouti FF, Irshaid YM, Suleiman AA, Abu-Hassan D, Tawil R. Elderly patients in family practice: poly pharmacy and inappropriate prescribing—Jordan. Int Med J. 2012;19(4):302–6.

    Google Scholar 

  6. Fick DM, Mion LC, Beers MH, L Waller J. Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health. 2008;31(1):42–51.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fu AZ, Jiang JZ, Reeves JH, Fincham JE, Liu GG, Perri M III. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. Med Care. 2007;45(5):472–6.

    Article  PubMed  Google Scholar 

  8. Hyttinen V, Jyrkkä J, Valtonen H. A systematic review of the impact of potentially inappropriate medication on health care utilization and costs among older adults. Med Care. 2016;54(10):950–64.

    Article  PubMed  Google Scholar 

  9. Suehs BT, Davis C, Franks B, Yuran TE, Ng D, Bradt J, et al. Effect of potentially inappropriate use of antimuscarinic medications on healthcare use and cost in individuals with overactive bladder. J Am Geriatr Soc. 2016;64(4):779–87. doi:10.1111/jgs.14030.

    Article  PubMed  Google Scholar 

  10. Wein AJ, Rovner ES. Definition and epidemiology of overactive bladder. Urology. 2002;60(5 Suppl 1):7–12 discussion.

    Article  PubMed  Google Scholar 

  11. Hartmann KE, McPheeters ML, Biller DH, Ward RM, McKoy JN, Jerome RN, et al. Treatment of overactive bladder in women. Evid Rep Technol Assess (Full Rep). 2009;187:1–120.

    Google Scholar 

  12. Ganz ML, Smalarz AM, Krupski TL, Anger JT, Hu JC, Wittrup-Jensen KU, et al. Economic costs of overactive bladder in the United States. Urology. 2010;75(3):526. doi:10.1016/j.urology.2009.06.096.

    Article  PubMed  Google Scholar 

  13. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Societ updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. doi:10.1111/j.532-5415.2012.03923.x [Epub 2012 Feb 29].

    Article  Google Scholar 

  14. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. doi:10.1111/jgs.13702.

    Article  Google Scholar 

  15. Frytak JR, Henk HJ, Zhao Y, Bowman L, Flynn JA, Nelson M. Health service utilization among Alzheimer’s disease patients: evidence from managed care. Alzheim Dement. 2008;4(5):361–7.

    Article  Google Scholar 

  16. Zhao Y, Kuo TC, Weir S, Kramer M, Ash A. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Serv Res. 2008;8(1):108.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.

    Article  CAS  PubMed  Google Scholar 

  18. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–9.

    Article  PubMed  Google Scholar 

  19. Farley JF, Harley CR, Devine JW. A comparison of comorbidity measurements to predict healthcare expenditures. Am J Manag Care. 2006;12(2):110.

    PubMed  Google Scholar 

  20. Carney CP, Jones L, Woolson RF. Medical comorbidity in women and men with schizophrenia: a population-based controlled study. J Gen Int Med. 2006;21(11):1133–7.

    Article  Google Scholar 

  21. Klabunde CN, Potosky AL, Legler JM, Warren JL. Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000;53(12):1258–67.

    Article  CAS  PubMed  Google Scholar 

  22. Newcomer R, Clay T, Luxenberg JS, Miller RH. Misclassification and selection bias when identifying Alzheimer’s disease solely from Medicare claims records. J Am Geriatr Soc. 1999;47(2):215–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Mary Costantino, PhD, for editing and formatting this manuscript.

Author information

Authors and Affiliations

  1. Comprehensive Health Insights, Inc, 515 West Market Street, 7th Floor, Louisville, KY, 40202, USA

    Brandon T. Suehs & Cralen Davis

  2. Astellas Pharma Global Development, Northbrook, IL, USA

    Daniel B. Ng & Katherine Gooch

Authors
  1. Brandon T. Suehs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cralen Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel B. Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katherine Gooch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brandon T. Suehs.

Ethics declarations

Conflict of interest

This research was conceived, funded, and carried out collaboratively by Humana Inc., Astellas Pharma Global Development, and Comprehensive Health Insights, Inc. BS and CD are employees of Comprehensive Health Insights, a wholly owned subsidiary of Humana Inc., and are stockholders of Humana, Inc. DN and KG are employees of Astellas Pharma Global Development, Inc.

Funding

Comprehensive Health Insights, Inc. received funding support from Astellas Pharma Global Development, Inc. in connection with conducting this study and for the development of this manuscript.

Ethical approval and informed consent

Prior to study initiation, the research protocol was approved by an independent Institutional Review Board (Schulman IRB; Cincinnati, OH, USA; IRB # 201308055).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suehs, B.T., Davis, C., Ng, D.B. et al. Impact of 2015 Update to the Beers Criteria on Estimates of Prevalence and Costs Associated with Potentially Inappropriate Use of Antimuscarinics for Overactive Bladder. Drugs Aging 34, 535–543 (2017). https://doi.org/10.1007/s40266-017-0464-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-017-0464-8

Search

Navigation