WHICH MEDICATION IS WITHDRAWN FIRST IN PATIENTS RECEIVING POLYPHARMACY? - A ANALYSIS USING HEALTH INSURANCE CLAIMS DATABASE
Author(s)
Kosuke Iwasaki, MBA1, AYANO CHIDA, B.S.2, Fumikazu Shimamura, LLB2, Takeshi Iimura, MD3;
1Milliman, Inc., Principal, Chiyoda-ku, Tokyo, Japan, 2Milliman Inc., Tokyo, Japan, 3Kobe Kaisei Hospital, Kobe, Japan
1Milliman, Inc., Principal, Chiyoda-ku, Tokyo, Japan, 2Milliman Inc., Tokyo, Japan, 3Kobe Kaisei Hospital, Kobe, Japan
OBJECTIVES: Polypharmacy has been recognized as a concern in terms of both healthcare costs and patient safety. For example, the Ministry of Health, Labour and Welfare of Japan states in its Guidelines that "the risk of adverse events increases with the use of six or more medications." In this study, we used real-world data to investigate which medications are most likely to be discontinued first when reducing the number of drugs in patients undergoing polypharmacy.
METHODS: From a Japanese health insurance claims database owned by DeSC Healthcare, we identified patients aged 75 years and older who were prescribed six or more distinct drug ingredients in a single month. Among them, we further extracted individuals who had been prescribed six ingredients for at least three consecutive months, followed by a reduction to five ingredients for at least three consecutive months. We then investigated which drug ingredients had been discontinued.
RESULTS: Among the 17.5 million insured individuals in the DeSC Healthcare database, 6.7 million were aged 75 years or older. Of these, 5.2 million (77%) had at least one month in which they were prescribed six or more distinct drug ingredients. Excluding OTC-equivalent drugs, we identified 19,896 patients who transitioned from a regimen of six ingredients to five ingredients. The top three discontinued drug ingredients in this group were amlodipine (733 patients; antihypertensive), celecoxib (471 patients; NSAID), and sodium ferrous citrate (366 patients; treatment for iron-deficiency anemia). In cases where amlodipine was discontinued, the most commonly co-prescribed drug classes during the six-ingredient months were: first, ARBs (angiotensin II receptor blockers); second, tranquilizers; and third, lipid-lowering agents. Amlodipine was discontinued in preference to these medications.
CONCLUSIONS: Among patients undergoing polypharmacy, amlodipine is frequently the first medication to be discontinued. Whether this leads to issues in blood pressure control requires further investigation.
METHODS: From a Japanese health insurance claims database owned by DeSC Healthcare, we identified patients aged 75 years and older who were prescribed six or more distinct drug ingredients in a single month. Among them, we further extracted individuals who had been prescribed six ingredients for at least three consecutive months, followed by a reduction to five ingredients for at least three consecutive months. We then investigated which drug ingredients had been discontinued.
RESULTS: Among the 17.5 million insured individuals in the DeSC Healthcare database, 6.7 million were aged 75 years or older. Of these, 5.2 million (77%) had at least one month in which they were prescribed six or more distinct drug ingredients. Excluding OTC-equivalent drugs, we identified 19,896 patients who transitioned from a regimen of six ingredients to five ingredients. The top three discontinued drug ingredients in this group were amlodipine (733 patients; antihypertensive), celecoxib (471 patients; NSAID), and sodium ferrous citrate (366 patients; treatment for iron-deficiency anemia). In cases where amlodipine was discontinued, the most commonly co-prescribed drug classes during the six-ingredient months were: first, ARBs (angiotensin II receptor blockers); second, tranquilizers; and third, lipid-lowering agents. Amlodipine was discontinued in preference to these medications.
CONCLUSIONS: Among patients undergoing polypharmacy, amlodipine is frequently the first medication to be discontinued. Whether this leads to issues in blood pressure control requires further investigation.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH131
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas