Excessive reliance on class effect could negatively impact geriatric care

Too much reliance on class effect could undermine the medical care of geriatric patients, according to an article published in the Journal of the American Geriatric Society. In turn, the clinical community should work to ensure that sufficient choices remain to prescribe wisely for elderly patients, authors Mark H. Beers, MD, and Richard G. Stefanacci, DO, stated.

The notion of class effect is growing, the authors stated, and if adopted in its entirety, would become the governing notion behind the Medicare Prescription Drug Plan. HMOs, PBMs, and other parties that advocate cost containment would likely "apply all their might" to support such a model, the authors predicted.

Drs Beers and Stefanacci concede that the value of class effect would be "enormous" and would help to organize an increasing number of drugs into useful categorizations, which would allow prescribers to focus their clinical attention on specific issues.

As an example, the authors cited the first-generation of benzodiazepines, which were much better than the class they had replaced but still posed significant side effects to elderly patients. Drug companies overcame those side effects, but the improved drugs cost more. In a cost-driven, class-based pharmacopeia, such incentive would be missing if the new and improved drugs had little hope of appearing on formularies.

Hence, Drs Beers and Stefanacci concluded that the quality of medication use by America's older people would be turned back "more than 50 years" if class alone, even with a few subclasses, became the standard of formulary development.

SOURCE Beers MH, Stefanacci RG. The class effect: Is it relevant to geriatrics? J Am Geriatr Soc. 2005;53:1402–1404.