New Delhi: Co-morbidities, prolonged hospitalisation, inappropriate medications, polypharmacy and parenteral medications being prescribed contribute to increased drug expenditure in elderly patients, a study has said.
The study titled 'Pharmacoeconomics of drugs used for older persons in a tertiary care hospital in Delhi', published in the Indian Journal of Medical Research (IJMR) in February, emphasizes the need to formulate a drug policy for them . Monitoring expenditure on prescribed medicines in view of the increasing number of geriatric patients.
The hospital-based observational study, involving 1,000 geriatric patients aged 60 years and above, was conducted at the Department of Medicine and Pharmacology, Maulana Azad Medical College and Affiliated Lok Naya Hospital, New Delhi. Demographic characteristics, prescribed medicines, Data were collected regarding expenditure incurred, appropriateness of prescribed medicine and adverse drug reactions (ADRs).Of the total persons admitted to the ward during the study period, 41.3 per cent were elderly patients.
A total of 8,366 medicines were prescribed in 127 formulations. The total expenditure on prescribed medicines was Rs 1,087,175 and the per capita expenditure was Rs 1,087. 91 per cent of the expenditure on medicines is on parenteral medicines. The maximum expenditure (70 per cent) on prescribed medicines is at 11.9 per cent.The study found that per capita expenditure was significantly higher among individuals with co-morbidities and those with longer hospital stays.
About 28.1 percent of prescriptions were inappropriate. Additionally, ADRs (140) were observed in 139 (13.9 percent) patients. Individuals with inappropriate drug prescriptions and ADRs had a longer length of hospital stay and were prescribed a greater number of drugs, the study said.
The researchers stressed that specific policies are needed for health care, including medicines, for the elderly.In this study, since most of the medicines were provided free of cost by the hospital, the out-of-pocket OOP expenditure was quite low (5.75 per cent) compared to some international studies where OOP expenditure on prescription medicines was high (18 per cent), they said. Individuals with gastrointestinal disorders had the highest per capita expenditure on medicines, followed by those with genito-urinary disorders.
The National Health Policy 2017 recognized the health care needs of the rural elderly population and specified that primary health care should include geriatric care.
Researchers said both the central and state governments have launched social insurance schemes and government-based voluntary insurance schemes.Pradhan Mantri Jan Arogya Yojana is a part of Ayushman Bharat, the world's largest social insurance scheme launched in 2018 by the Government of India. In this scheme, all the families belonging to the poorest, bottom 40 percent of the population are eligible to get its benefits. Up to Rs five lakh per year to each family for secondary and tertiary care.
Ayushman Bharat replaced two earlier schemes: the centrally funded National Health Insurance Scheme and the Senior Citizens Health Insurance Scheme (2016). He said disaggregated data on these and other social insurance schemes, particularly with regard to the old age population, are not available.He said that in the absence of data, it is difficult to comment on the impact of the benefits of these schemes on the aging population. "What is available is that the share of households, including insurance contributions, is 71 per cent of the current health expenditure (CHE) share (320,262 crore). Moreover, the total pharmaceutical expenditure is 37 per cent of CHE." They said.
“Keeping the above in mind, there is a need for a multi-pronged strategy to look after the health and especially the medical needs of geriatric patients.Enhanced pension schemes, financial support through social insurance schemes, access to low-cost quality essential medicines is one such multi-component approach.
"A drug policy focusing specifically on geriatric pharmacotherapy will take care of the drug needs as well as costs for the increasing number of geriatric individuals," the researchers said. The researchers recommended that for older individuals A drug policy should be formulated with special consideration, healthcare providers should be made aware of rational prescription for the elderly, a system should be established to monitor drug use with economic evaluation in public health systems and the elderly should be Pharmacovigilance to monitor ADRs.
According to the 2011 census, there are approximately 100 million people above 60 years of age in India, including the old age.
According to the United Nations Population Division, India's share of the old age population is projected to increase to 19 percent of the global old age population by 2050, which is about 300 million.The study notes that most patients in this age group have co-morbidities that require multiple medications. Health care costs are of particular concern for the elderly population who are financially dependent and physically are less capable. It is estimated that health care costs alone put approximately 63 million people at risk of poverty each year. It has been observed that households with elderly members spend 3.8 times more on health than households without elderly members.
It is estimated that by 2030, 45 percent of the health care burden in India will be borne by the elderly.
The study titled 'Pharmacoeconomics of drugs used for older persons in a tertiary care hospital in Delhi', published in the Indian Journal of Medical Research (IJMR) in February, emphasizes the need to formulate a drug policy for them . Monitoring expenditure on prescribed medicines in view of the increasing number of geriatric patients.
The hospital-based observational study, involving 1,000 geriatric patients aged 60 years and above, was conducted at the Department of Medicine and Pharmacology, Maulana Azad Medical College and Affiliated Lok Naya Hospital, New Delhi. Demographic characteristics, prescribed medicines, Data were collected regarding expenditure incurred, appropriateness of prescribed medicine and adverse drug reactions (ADRs).Of the total persons admitted to the ward during the study period, 41.3 per cent were elderly patients.
A total of 8,366 medicines were prescribed in 127 formulations. The total expenditure on prescribed medicines was Rs 1,087,175 and the per capita expenditure was Rs 1,087. 91 per cent of the expenditure on medicines is on parenteral medicines. The maximum expenditure (70 per cent) on prescribed medicines is at 11.9 per cent.The study found that per capita expenditure was significantly higher among individuals with co-morbidities and those with longer hospital stays.
About 28.1 percent of prescriptions were inappropriate. Additionally, ADRs (140) were observed in 139 (13.9 percent) patients. Individuals with inappropriate drug prescriptions and ADRs had a longer length of hospital stay and were prescribed a greater number of drugs, the study said.
The researchers stressed that specific policies are needed for health care, including medicines, for the elderly.In this study, since most of the medicines were provided free of cost by the hospital, the out-of-pocket OOP expenditure was quite low (5.75 per cent) compared to some international studies where OOP expenditure on prescription medicines was high (18 per cent), they said. Individuals with gastrointestinal disorders had the highest per capita expenditure on medicines, followed by those with genito-urinary disorders.
The National Health Policy 2017 recognized the health care needs of the rural elderly population and specified that primary health care should include geriatric care.
Researchers said both the central and state governments have launched social insurance schemes and government-based voluntary insurance schemes.Pradhan Mantri Jan Arogya Yojana is a part of Ayushman Bharat, the world's largest social insurance scheme launched in 2018 by the Government of India. In this scheme, all the families belonging to the poorest, bottom 40 percent of the population are eligible to get its benefits. Up to Rs five lakh per year to each family for secondary and tertiary care.
Ayushman Bharat replaced two earlier schemes: the centrally funded National Health Insurance Scheme and the Senior Citizens Health Insurance Scheme (2016). He said disaggregated data on these and other social insurance schemes, particularly with regard to the old age population, are not available.He said that in the absence of data, it is difficult to comment on the impact of the benefits of these schemes on the aging population. "What is available is that the share of households, including insurance contributions, is 71 per cent of the current health expenditure (CHE) share (320,262 crore). Moreover, the total pharmaceutical expenditure is 37 per cent of CHE." They said.
“Keeping the above in mind, there is a need for a multi-pronged strategy to look after the health and especially the medical needs of geriatric patients.Enhanced pension schemes, financial support through social insurance schemes, access to low-cost quality essential medicines is one such multi-component approach.
"A drug policy focusing specifically on geriatric pharmacotherapy will take care of the drug needs as well as costs for the increasing number of geriatric individuals," the researchers said. The researchers recommended that for older individuals A drug policy should be formulated with special consideration, healthcare providers should be made aware of rational prescription for the elderly, a system should be established to monitor drug use with economic evaluation in public health systems and the elderly should be Pharmacovigilance to monitor ADRs.
According to the 2011 census, there are approximately 100 million people above 60 years of age in India, including the old age.
According to the United Nations Population Division, India's share of the old age population is projected to increase to 19 percent of the global old age population by 2050, which is about 300 million.The study notes that most patients in this age group have co-morbidities that require multiple medications. Health care costs are of particular concern for the elderly population who are financially dependent and physically are less capable. It is estimated that health care costs alone put approximately 63 million people at risk of poverty each year. It has been observed that households with elderly members spend 3.8 times more on health than households without elderly members.
It is estimated that by 2030, 45 percent of the health care burden in India will be borne by the elderly.