{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:30:42Z","timestamp":1790238642488,"version":"4.1.0"},"reference-count":63,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100001590","name":"Health Research Board","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001590","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,11,26]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the economic impact of three drugs commonly involved in potentially inappropriate prescribing (PIP) in adults aged \u226565 years, including their adverse effects (AEs): long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines and proton pump inhibitors (PPIs) at maximal dose; to assess cost-effectiveness of potential interventions to reduce PIP of each drug.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cost-utility analysis. We developed Markov models incorporating the AEs of each PIP, populated with published estimates of probabilities, health system costs (in 2014 euro) and utilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A hypothetical cohort of 65\u2009year olds analysed over 35 1-year cycles with discounting at 5% per year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Incremental cost, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios with 95% credible intervals (CIs, generated in probabilistic sensitivity analysis) between each PIP and an appropriate alternative strategy. Models were then used to evaluate the cost-effectiveness of potential interventions to reduce PIP for each of the three drug classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All three PIP drugs and their AEs are associated with greater cost and fewer QALYs compared with alternatives. The largest reduction in QALYs and incremental cost was for benzodiazepines compared with no sedative medication (\u20ac3470, 95%\u2009CI \u20ac2434 to \u20ac5001; \u22120.07 QALYs, 95%\u2009CI \u22120.089 to \u20130.047), followed by NSAIDs relative to paracetamol (\u20ac806, 95%\u2009CI \u20ac415 and \u20ac1346; \u22120.07 QALYs, 95%\u2009CI \u22120.131 to \u20130.026), and maximal dose PPIs compared with maintenance dose PPIs (\u20ac989, 95%\u2009CI -\u20ac69 and \u20ac2127; \u22120.01 QALYs, 95%\u2009CI \u22120.029 to 0.003). For interventions to reduce PIP, at a willingness-to-pay of \u20ac45\u2009000 per QALY, targeting NSAIDs would be cost-effective up to the highest intervention cost per person of \u20ac1971. For benzodiazepine and PPI interventions, the equivalent cost was \u20ac1480 and \u20ac831, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term benzodiazepine and NSAID prescribing are associated with significantly increased costs and reduced QALYs. Targeting inappropriate NSAID prescribing appears to be the most cost-effective PIP intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-021832","type":"journal-article","created":{"date-parts":[[2019,1,31]],"date-time":"2019-01-31T05:05:20Z","timestamp":1548911120000},"page":"e021832","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["Economic impact of potentially inappropriate prescribing and related adverse events in older people: a cost-utility analysis using Markov models"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9838-3625","authenticated-orcid":false,"given":"Frank","family":"Moriarty","sequence":"first","affiliation":[{"name":"HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitriona","family":"Cahir","sequence":"additional","affiliation":[{"name":"Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Bennett","sequence":"additional","affiliation":[{"name":"Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5896-5783","authenticated-orcid":false,"given":"Tom","family":"Fahey","sequence":"additional","affiliation":[{"name":"HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,1,30]]},"reference":[{"key":"2025120518363445000_9.1.e021832.1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12161"},{"key":"2025120518363445000_9.1.e021832.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-008656","article-title":"Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study","volume":"5","author":"Moriarty","year":"2015","journal-title":"BMJ Open"},{"key":"2025120518363445000_9.1.e021832.3","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.12059"},{"key":"2025120518363445000_9.1.e021832.4","doi-asserted-by":"publisher","DOI":"10.1007\/BF03319105"},{"key":"2025120518363445000_9.1.e021832.5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12913-016-1366-x","article-title":"Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list","volume":"16","author":"Pohl-Dernick","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"2025120518363445000_9.1.e021832.6","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/BF02599040","article-title":"Excess costs from gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs","volume":"11","author":"Smalley","year":"1996","journal-title":"J Gen Intern Med"},{"key":"2025120518363445000_9.1.e021832.7","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201200089"},{"key":"2025120518363445000_9.1.e021832.8","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-015-0251-3"},{"key":"2025120518363445000_9.1.e021832.9","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-014-0148-8"},{"key":"2025120518363445000_9.1.e021832.10","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14133"},{"key":"2025120518363445000_9.1.e021832.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f1049"},{"key":"2025120518363445000_9.1.e021832.12","doi-asserted-by":"crossref","unstructured":"Briggs A , Claxton K , Sculpher M . 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