The economic impact of potentially inappropriate medications in older stroke patients: a comparison of criteria

Authors

Keywords:

cost savings; potentially inappropriate medication list; stroke; Vietnam

Abstract

Background: Potentially inappropriate medications (PIMs) disproportionally affect the quality of life of patients aged 65 years or older and are associated with increased direct healthcare costs. However, evidence on their economic impact remains limited in the Vietnamese context.

Objectives: To compare the potential costs associated with PIMs as measured using three tools (Beers, STOPP/START, and MALPIP), in elderly stroke patients.

Methods: A descriptive cross-sectional study was conducted in 300 acute stroke patients aged 65 years and older receiving inpatient treatment at a hospital in Can Tho City, Vietnam, from January to July 2024.

Results: The mean total direct healthcare cost per patient was VND 2,918,149. STOPP/START produced the highest estimated savings across all scenarios. Under the 100% discontinuation scenario, the total cost savings were VND 117,637 per patient per treatment episode, including VND 109,416 saved by the health insurance fund and VND 8,221 saved in patient out-of-pocket payments.

Conclusion: The STOPP/START tool may better identify potentially avoidable medication-related costs. Healthcare professionals should consider integrating STOPP/START into routine medication reviews to help reduce unnecessary medication costs among older patients with stroke.

Downloads

Download data is not yet available.

References

1. Kallestrup-Lamb M, Marin AOK, Menon S, Søgaard J. Aging populations and expenditures on health [Internet]. J Econ Ageing. 2024;29:100518. DOI: https://www.doi.org/10.1016/j.jeoa.2024.100518

2. Thanh Trong N, Thi Dong N, Thi Ly P. Population aging and economic growth: evidence from ASEAN countries [Internet]. Cogent Bus Manag. 2024;11(1): 2298055. DOI: https://www.doi.org/10.1080/23311975.2023.2298055

3. Dee M, Lennon O, O’Sullivan C. A systematic review of physical rehabilitation interventions for stroke in low and lower-middle income countries [Internet]. Disabil Rehabil. 2020;42(4):473–501. DOI: https://www.doi.org/10.1080/09638288.2018.1501617

4. Meng X, Wang A, Wang R, Xu Q, Wu S, Han Y. EE208 Direct cost and indirect cost of ischemic stroke in China [Internet]. Value Health. 2022;25(12):S93–S94. DOI: https://www.doi.org/10.1016/j.jval.2022.09.457

5. Rajati F, Rajati M, Rasulehvandi R, Kazeminia M. Prevalence of stroke in the elderly: A systematic review and meta-analysis [Internet]. Interdiscip Neurosurg. 2023;32:101746. DOI: https://www.doi.org/10.1016/j.inat.2023.101746

6. Ngoc NH, Thong NV, Hien LX, An NQ, Thuan ND. Predictors of ischemic stroke in elderly patients in Vietnam [Internet]. Genet Mol Res. 2021;20(1):1-12. DOI: https://www.doi.org/10.4238/gmr18741

7. Tran MC, Prisco L, Pham PM, Phan HQ, Ganau M, Pham N, et al. Comprehensive analysis of stroke epidemiology in Vietnam: Insights from GBD 1990–2019 and RES-Q 2017–2023 [Internet]. Glob Epidemiol. 2025;9:100199. DOI: https://www.doi.org/10.1016/j.gloepi.2025.100199

8. Truyen TTTT, Vo NLY, Vo QP, Phan TC, Le PNB, Nguyen HT, et al. Burden and risk factors of stroke in Vietnam from 1990 to 2021 – a systematic analysis from Global Burden of Disease 2021 [Internet]. J Stroke Cerebrovasc Dis. 2025;34(3):108241. DOI: https://www.doi.org/10.1016/j.jstrokecerebrovasdis.2025.108241

9. Tian X, Yu M, Sun Y, Yan H, Ma H, Jiang L, et al. Evidence-based summary for the safety of multiple medication in elderly patients with ischemic stroke [Internet]. Ann Transl Med. 2022;10(4):202. DOI: https://www.doi.org/10.21037/atm-22-453

10. Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Patel T, Ho CH, et al. Medication self-management interventions for persons with stroke: A scoping review [Internet]. PLoS One. 2023;18(5):e0285483. DOI: https://www.doi.org/10.1371/journal.pone.0285483

11. Barow E, Probst AC, Pinnschmidt H, Heinze M, Jensen M, Rimmele DL, et al. Effect of comorbidity burden and polypharmacy on poor functional outcome in acute ischemic stroke [Internet]. Clin Neuroradiol. 2023;33(1):147–154. DOI: https://www.doi.org/10.1007/s00062-022-01193-8

12. Lin YJ, Peng LN, Chen LK, Lin MH, Hwang SJ. Risk factors of potentially inappropriate medications among older patients visiting the community health center in rural Taiwan [Internet]. Arch Gerontol Geriatr. 2011;53(2):225–228. DOI: https://www.doi.org/10.1016/j.archger.2010.11.017

13. Tan X, Lv X, Xiong W, Liu Y, Zhang N. Prevalence and factors associated with potentially inappropriate medications in elderly stroke patients: A comparison of Beers 2019 and 2023 criteria [Internet]. Saudi Pharm J. 2025;33(4):27. DOI: https://www.doi.org/10.1007/s44446-025-00029-z

14. Nguyen VT, Bang AV, Dang TTP. Prevalence of potentially inappropriate medication use among hospitalized elderly patients and associated factors [Internet]. Vietnam J Community Med. 2023;64(3):1-7. DOI: https://www.doi.org/10.52163/yhc.v64i3.633

15. Cojuc-Konigsberg G, Schoo C. Inappropriate medication in the geriatric population [Internet]. Treasure Island: StatPearls Publishing; 2025 [access: 02/02/2026]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK585118/

16. Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Reviewing potentially inappropriate medication in hospitalized patients over 65 using explicit criteria: A systematic literature review [Internet]. Drug Healthc Patient Saf. 2021;13:183–210. DOI: https://www.doi.org/10.2147/DHPS.S303101

17. American Geriatrics Society. 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults [Internet]. J Am Geriatr Soc. 2023;71(7):2052–2081. DOI: https://www.doi.org/10.1111/jgs.18372

18. O’Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 3 [Internet]. Eur Geriatr Med. 2023;14(4):625–632. DOI: https://www.doi.org/10.1007/s41999-023-00777-y

19. Chang CT, Chan HK, Cheah WK, Tan MP, Ch'ng ASH, Thiam CN, et al. Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): A Delphi study [Internet]. J Pharm Policy Pract. 2023;16(1):122. DOI: https://www.doi.org/10.1186/s40545-023-00630-4

20. Chang CT, Chan HK, Tan AY, Kamis SF, Yeo YL, Azman MA, et al. Comparing Beers, STOPP and MALPIP criteria in detecting potentially inappropriate medications, clinical outcomes, and cost impacts among older Malaysians: A cohort study [Internet]. J Pharm Policy Pract. 2024;17(1):2436896. DOI: https://www.doi.org/10.1080/20523211.2024.2436896

21. Heider D, Matschinger H, Meid AD, Quinzler R, Adler JB, Günster C, et al. The impact of potentially inappropriate medication on the development of health care costs and its moderation by the number of prescribed substances: Results of a retrospective matched cohort study [Internet]. PLoS One. 2018;13(7):e0198004. DOI: https://www.doi.org/10.1371/journal.pone.0198004

22. D’Aiuto C, Lunghi C, Guénette L, Berbiche D, Bertrand K, Vasiliadis HM. Health care system costs related to potentially inappropriate medication use involving opioids in older adults in Canada [Internet]. BMC Health Serv Res. 2023;23(1):1295. DOI: https://www.doi.org/10.1186/s12913-023-10303-2

23. Clark CM, Shaver AL, Aurelio LA, Feuerstein S, Wahler RG Jr, Daly CJ, et al. Potentially inappropriate medications are associated with increased healthcare utilization and costs [Internet]. J Am Geriatr Soc. 2020;68(11):2542–2550. DOI: https://www.doi.org/10.1111/jgs.16743

24. Tran HD, Hung TT, Thuy PTH, Tam LT, Tran HG, Le PH. Clinical features and treatment outcomes of COVID-19 admissions in the Can Tho City Hospital of Tuberculosis and Respiratory Diseases, Vietnam: A hospital-based observational study [Internet]. Healthcare (Basel). 2023;11(11): 1632. DOI: https://www.doi.org/10.3390/healthcare11111632

25. Thi NN, Thi KHH, Thi ATT, Ngoc HN, Huu TN. Analyzing inappropriate prescribing in the elderly by using Beers and STOPP/START criteria through clinical pharmaceutical activities at Nghi Loc General Hospital [Internet]. Vietnam Med J. 2022;515(2):117–122. DOI: https://www.doi.org/10.51298/vmj.v515i2.2770

26. Le TH, Nguyen NH. Evaluation of drug prescribing in the elderly inpatients using Beers criteria updated in 2019 [Internet]. Ho Chi Minh City J Med. 2020 [access: 02/02/2026];24(2):122–130. Available at: https://www.tapchiyhoctphcm.vn/articles/18141

27. Nguyen TV, Hoang MV, Doan HT, Nguyen VM. Direct medical cost for acute ischemic stroke patients in Vietnam [Internet]. J Popul Soc Stud. 2024;32:781–93. DOI: https://www.doi.org/10.25133/JPSSv322024.045

28. Than TTN, Nguyen TK, Nguyen VT. Study on direct medical costs in the treatment of acute ischemic stroke with alteplase at Binh Duong Provincial General Hospital in 2024–2025 [Internet]. Can Tho Med Pharm J. 2025;(88):246–52. DOI: https://www.doi.org/10.58490/ctump.2025i88.3567

Downloads

Published

2026-04-27

How to Cite

1.
Pham TKA, Ho TBNN, Dewey RS, Tran VD. The economic impact of potentially inappropriate medications in older stroke patients: a comparison of criteria. Rev. cuba. med. mil [Internet]. 2026 Apr. 27 [cited 2026 May 2];55(2):e026077441. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/77441

Issue

Vol. 55 No. 2 (2026): April - June (In Progress...)

Section

Research Article

License

Copyright (c) 2026 Tho Kieu Anh Pham, Thi Bui Nhu Ngoc Ho, Rebecca Susan Dewey, Van De Tran

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Authors who have publications with this Journal accept the following terms:

  • The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
  • The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
  • Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.