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Drug costs and use in VHA nursing homes: a national overview of long-stay residents.

French DD, Campbell RR, Spehar AM, Rubenstein LZ, Cunningham FE

VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL 33612, USA. Dustin.French@va.gov

OBJECTIVES: The aim of this study was to provide national annualized estimates of drug costs and use by drug classes for long-stay nursing home (NH) residents. DESIGN: National, descriptive, secondary data analysis. SETTING: National, Veterans Health Administration (VHA), 136 NHs. PARTICIPANTS: Our study population consisted of 6554 VHA long-stay NH residents, identified from the Minimum Data Set (MDS), who had an annual assessment during FY 2005 linked with 8,847,561 inpatient pharmacy claims. MEASUREMENT: Descriptive statistics of the annual drug costs and use by VHA therapeutic drug classes obtained from FY 2005 national pharmacy claims linked at the individual resident level. RESULTS: The total cost of the drugs was $23,782,717 in 326 drug classes for 6554 VHA NH residents. Average annual drug cost was $3629 per resident (99% Confidence Interval [CI], $3343-$3915). The top 20 drug classes accounted for nearly 70% of total drug costs for long-stay NH residents. Approximately three quarters (73.3%) of these residents received a non-opioid analgesic (eg, acetaminophen, aspirin). Over half of these residents received antidepressants (selective serotonin reuptake inhibitors [SSRIs]) (54.3%), or other anti-infective drugs (eg, bacitracin, ciprofloxacin) (53.3%). CONCLUSIONS: This is the first national study of drug costs and use for long-stay veterans in VHA NHs. It is essential in any study analyzing drug costs and use in NH patients to differentiate long-stay residents from short-stay patients. This kind of detailed cost and use analysis has implications for projecting future costs associated with the Medicare Part D prescription benefit for dually eligible NH residents.

Published 12 October 2007 in J Am Med Dir Assoc, 8(8): 515-8.
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