Work

Polypharmacy and healthcare expenditures among older adults in the United States: a propensity score-matched study

Year: 2025

Type: article

Abstract: BACKGROUND: Polypharmacy is associated with increased risk of adverse events and may increase healthcare expenditures. However, there is a lack of study using nationally representative data to assess additional healthcare costs associated with polypharmacy. This study aimed to quantify the associations between polypharmacy and healthcare expenditures and affordability of healthcare among older adults. METHODS: We used data from the Medical Expenditure Panel Survey (MEPS) from 2018 to 2021, which provides nationally presentative data in the US. Polypharmacy was defined as using ≥ 5 medications in the survey year. We included 23,300 adult participants aged 65 years or older (13,339 with and 9,961 without polypharmacy). Propensity score matching (PSM) was employed to control for sociodemographic and an extensive list of comorbidities. We used a two-part model to examine associations between polypharmacy and healthcare expenditures and logistic regression to examine associations between polypharmacy and affordability of care. Unaffordability of care was defined as not or delay receiving healthcare because patients could not afford it in the past 12 months. RESULTS: After PSM, 4,925 participants with polypharmacy and 4,925 without polypharmacy were included. The mean (95% confidence interval, CI) age of study population was 73.9 (95% CI: 73.8-74.2) years, with 54.5% (95% CI: 54.0-55.0) being female. All characteristics were well-balanced (standardized mean differences < 0.1 for all). Following PSM, the average annual total expenditure was $14,691.06 for older adults with polypharmacy and $8,912.09 for those without. Polypharmacy was associated with $4,303.82 (95% CI: 3,948.56-4,659.08) higher annual total healthcare expenditures, including $1,178.67 (95% CI: 1,165.10-1,192.38) more for prescription medicines, $1,359.83 (95% CI: 885.14-1,884.52) more for office-based visits, $814.91 (95% CI: 176.77-1,192. 06) more for inpatient stays, and $886.16 (95% CI: 322.48-1,449.83) more for outpatient visits. Furthermore, polypharmacy was associated with significantly higher risk of unaffordability of prescription medications (adjusted odds ratio [95% CI] 1.70 [1.30-2.23]). CONCLUSIONS: Using propensity score methods, we provided estimates of additional healthcare costs associated with polypharmacy. Our research highlights the potential economic burden of polypharmacy on patients, family, insurers, and society.

Source: BMC Geriatrics

DOI: 10.1186/s12877-025-06545-w