title: Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list.
abstract: BACKGROUND
  Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list.
  
  
  METHODS
  Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios.
  
  
  RESULTS
  In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million.
  
  
  CONCLUSIONS
  The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.
authors.affiliation: Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany. katharina.pohl-dernick@fau.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Pohl-Dernick
authors.affiliation: Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Meier
authors.affiliation: Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Fahrstr. 17, 91054, Erlangen, Germany.
authors.forename: Renke
authors.initials: R
authors.lastname: Maas
authors.affiliation: Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Schöffski
authors.affiliation: Junior Professor for Health Services Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Emmert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital; D000067561:Potentially Inappropriate Medication List
keywords: Drug Reimbursement; Elderly; PRISCUS; Potentially inappropriate medication; Reimbursement costs