Unhealthy lifestyles are significant contributors to the cost of providing healthcare services to the nation's military personnel, military retirees, and their dependents. The continued rise in healthcare costs could impact other DoD programs and could potentially affect areas related to military capability and readiness. In 2006, DoD initiated Healthy Choices for Life initiatives to address the high cost of unhealthy lifestyles and behaviors, and the DoD continues to monitor lifestyle trends through the DoD Lifestyle Assessment Program.

This study examines the economic burden of alcohol misuse to the Department of Defense (DoD) and the benefits of reduced binge drinking among beneficiaries in the DoD's TRICARE Prime plan. Data analyzed include administrative records for approximately 3 million beneficiaries age 18 to 64, DoD's Survey of Health Related Behaviors Among Military Personnel, and the National Survey on Drug Use and Health. Alcohol misuse among Prime beneficiaries cost the DoD an estimated $1.2 billion in 2006--$425 million in higher medical costs and $745 million in reduced readiness and misconduct charges. Potential annual gross benefits to the DoD of reduced binge drinking are simulated for three scenarios: (1) implementing a comprehensive alcohol screening with referral to brief intervention or treatment by primary care ($87 million/$129 million in short/long-term benefits); (2) increasing the price of alcoholic beverages on military installations by 20% ($75 million/$115 million); and (3) implementing a Web-based education program ($81 million/$123 million).

he simultaneous use of multiple prescription medications has been repeatedly identified as an area of concern, particularly among our nation' s older adults.1 While older adults typically require more medications to manage multiple comorbidities, disease-centric prescribing, reduced organ function, and higher use of over-the-counter products among older adults complicates a prescriber' s or pharmacist' s ability to anticipate how concomitant use of multiple medications is likely to affect the underlying mechanisms by which each functions as prescribed.2,3 While risks associated with use of specific medications or combinations of medications among older patients have been well characterized, 4-6 assimilation of this information into prescribing practice is not evident. Perhaps many prescribers simply cannot consider all the medications their patients are already taking when they prescribe a new medication. 7 The likelihood of patients becoming confused by or noncompliant with their own drug regimen also increases with the size of their medication list.2 Too often, a critical review of a patient' s medication use is not conducted until after an adverse drug event occurs and has been recognized as such. 8Many of the studies examining multiple medication use by older adults to date have focused on non-U.S. populations, whereas studies on U.S. populations have focused more on inappropriate prescribing and medication-specific risks. Among the available literature, there is general agreement that multiple prescription medication use is more prevalent among older adults, women, and cardiovascular patients, but estimates vary widely and comparison of findings is complicated by the absence of a standard time period over which medication use ABSTRACT BACKGROUND: The simultaneous use of multiple prescription medications has been associated with an increased risk of adverse drug events and other drug-related complications, especially in the elderly.OBJECTIVE: To quantify the prevalence of use of multiple medications among a sample of Department of Defense (DoD) health care beneficiaries, aged 65 years and older, who used their TRICARE (military health care services) benefit to obtain prescription medication.METHODS: Outpatient pharmacy fill records were analyzed for a 10% random sample of 1.27 million TRICARE beneficiaries aged 65 years and older who obtained 1 or more prescription medications in the 90-day period from (P <0.001). The prevalence of multiple drug use peaked among beneficiaries aged 80 to 84 years. Cardiovascular drugs, central nervous system agents, and hormones and synthetic substitutes were the 3 most common therapeutic categories used by 77%, 48%, and 42% of beneficiaries, respectively.CONCLUSION: This baseline analysis documented the common use of multiple medications among TRICARE beneficiaries. The DoD faces a challenge similar to that of Medicare Part D drug plans to cost-effectively monitor and optimize pharmacotherapy for its older beneficiaries.

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Health-promotion interventions are needed to improve the health status of this population and to achieve the goals set forth in Healthy People 2010.