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We aimed to estimate direct PIM cost trends from 2012 to 2021 among older women and men in Quebec, Canada.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Using medico-administrative data, we assessed direct costs paid by the public insurer (medication cost and professional fee, excluding out-of-pocket payments by individuals) of PIMs claimed by adults \u226565 years covered by the public drug plan. Costs for 16 PIM classes, identified using 2015 and 2019 Beers criteria, were calculated and stratified by sex and age group (65-74, 75-84, \u226585) for each fiscal year. We assessed the proportion of PIMs among all medication expenditures. We computed average costs\/enrollee and usage prevalence for the costliest PIM classes. Trends were estimated using univariate linear regression with 95% confidence intervals.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>We found a non-statistically significant decrease in total PIM claim costs, from $206 million in 2012 to $186 million in 2021 (trend: -2.9[-17.4; 11.6]), representing 5.4% of medication expenditures for adults \u226565 in 2021. The reduction in total costs was more accentuated in women, whose annual costs were higher than those of men in all age groups. Average cost\/enrollee decreased from $179 to $119 (trend: -7[-19; 5]), with a drop from $216 to $142 for women and $132 to $92 for men. Costs\/enrollee were higher in 75-84 and \u226585 age groups. Costliest PIM classes included proton-pump inhibitors, benzodiazepines, antipsychotics, antidepressants, estrogens (women), and hypoglycemic agents (men). Cost trends did not always follow prevalence trends for these PIM classes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>PIM costs among older adults slightly decreased from 2012 to 2021. Appropriate prescribing and deprescribing appear crucial for reducing these costs. Further research should focus on estimating the societal impact and the cost-effectiveness analysis of deprescribing initiatives and other regulatory measures.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12877-025-06235-7","type":"journal-article","created":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T14:27:33Z","timestamp":1754144853000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost trends of potentially inappropriate medications among older adults between 2012 and 2021 in Quebec, Canada: a population-based repeated cross-sectional study"],"prefix":"10.1186","volume":"25","author":[{"given":"Magalie","family":"Gagnon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1718-5307","authenticated-orcid":false,"given":"Jason Robert","family":"Guertin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3294-7883","authenticated-orcid":false,"given":"Caroline","family":"Sirois","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9424-1926","authenticated-orcid":false,"given":"Marc","family":"Simard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1765-9130","authenticated-orcid":false,"given":"Beno\u00eet","family":"Cossette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0261-0879","authenticated-orcid":false,"given":"Marie-Eve","family":"Gagnon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,2]]},"reference":[{"key":"6235_CR1","unstructured":"Canadian Institute for Health Information. 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