Affiliations: [a] Pharmacie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| [b]
Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France
| [c]
Research Clinic Centre (CRC)eVCF (Aging Brain Frailty), Lyon Institute For Elderly, Hospices civils de Lyon, Lyon, France
| [d]
University Lyon 1, INSERM, U1028, UMR CNRS, Research Centre of Neurosciences of Lyon, Lyon, France
Correspondence:
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Correspondence to: Frederic Gervais, PharmD, PhD Candidate, Pharmaceutical Department, Charpennes Hospital, 27 rue Gabriel Péri, Hospices Civils de Lyon, F-69100, France. Tel.: +33 4 72 43 20 66; E-mail: frederic.gervais@chu-lyon.fr.
Abstract: Background:Literature supports an increasing number of older patients living with neurocognitive disorders alongside with their annual worldwide costs. Therapeutic management of behavioral and psychological symptoms includes the use of anticholinergic and sedative drugs for which significant exposure is negatively associated with clinical outcomes. Objective:The aim of this study was to assess the healthcare costs differences related to an increase in the exposure to anticholinergic and sedative drugs in older patients with neurocognitive disorder. Methods:A longitudinal study was conducted during 3 years on 1,604 participants of the MEMORA cohort linked with both regional public health insurance and hospital discharge databases between 2012 and 2017. Direct medical and non-medical costs were included. Exposure to anticholinergic and sedative drugs was measured by the drug burden index (DBI). Results:Costs difference associated with a DBI≥0.5 were + 338€ (p < 0.001). After adjustment on comorbidities, NCD stage, cognitive impairment, functional limitation, polypharmacy, and sociodemographic characteristics, a DBI≥0.5 was found to be an independent predictor of an increase of total healthcare costs by 22%(p < 0.001). Conclusion:Anticholinergic and sedative drugs have a substantial economic burden among older patients with neurocognitive disorder. More studies are required to assess the clinical and economic impact of an efficient strategy based on the reduction of the exposure to anticholinergic and sedative drugs and the promotion of non-pharmacological interventions.
Keywords: Adverse effects, aging, cholinergic antagonists, cost of illness, drug effects, hypnotics and sedatives, longitudinal studies
