Direct costs and hospital morbimortality impact from preventable adverse drug events
Keywords:
Drug toxicity, hospitals, costs and cost analysis, evaluation studies, Colombia
Abstract
Introduction. Implementing pharmacovigilance activities consists of monitoring and assessment of activities related to medical attention. However, additional data are necessary to identify conditions where care quality can be improved. Therefore, a focus on adverse drug events analysis from a prevention and economic perspective is needed, with emphasis on its local impact.
Objective. Preventable adverse drug events were summarized to establishing their impact on morbidity and mortality, as well as to estimate the ensuing economic burden.
Materials and methods. The data were gathered from a level 3 hospital (high complexity), located in Bogotá, Colombia, where specific pharmacovigilance activities were recorded in 2007. Patient charts were reviewed to characterize adverse drug events according to their causality, severity and preventability. Direct costs were estimated by grouping diagnostic tests, length of hospitalization, procedures and additional drugs required.
Results. The charts of 283 patients and 448 reports were analyzed. These data indicated that 24.8% of adverse drug events were preventable and that an associated mortality of 1.1% had occurred. The associated direct costs were between USD $16,687 and $18,739. Factors more commonly associated with preventability were drug-drug interactions, as well as inappropriate doses and unsuitable frequencies at which the drugs were administrated.
Conclusions. The data recommended that actions be taken to decrease preventable adverse drug events, because of negative impact on patient's health, and unnecessary consumption of healthcare resources.
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References
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18. Tribiño G, Maldonado C, Segura O, Díaz J. Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá. Biomédica. 2006;26:31-41.
19. Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: A prospective analysis of 3,695 patient-episodes. PLoS One. 2009;4:e4439.
20. Ajayi F, Sun H, Perry J. Adverse drug reactions: A review of relevant factors. J Clin Pharmacol. 2000;40:1093-101.
21. Krahenbuhl-Melcher A, Schlienger R,Lampert M, Haschke M, Dreive J, Krahenbuhd S. Drug-related problems in hospitals. A review of the recent literature. Drug Saf. 2007;30:379-407.
22. Gholami K, Shalviri G. Factors associated with preventability, predictability, and severity of adverse drug reactions. Ann Pharmacother. 1999;33:236-40.
23. Winterstein AG, Hatton RC, González-Rothi R, Johns TE, Segal R. Identifying clinically significant preventable adverse drug events through a hospital's database of adverse drug reaction reports. Am J Health Syst Pharm. 2002;59:1742-9.
24. Comité de Consenso. Tercer Consenso de Granada sobre problemas relacionados con medicamentos (PRM) y resultados negativos asociados a la medicación (RNM). Ars Pharm. 2007;48:5-17.
25. Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277:307-31.
26. Lagnaoui F, Moore N, Fach L, Longy-Boursier M, Begaud B. Adverse drug reactions in a department of systemic diseases-oriented internal medicine: Prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol. 2000;55:181-6.
2. Brennan TA, Leape LL, Laird NM, Hebert L, Localio R, Lwthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study. N Engl J Med. 1991;324:370-6.
3. Gautier S, Bachelet H, Bordet R, Caron J. The cost of adverse drug reactions. Expert Opin Pharmacother. 2003;4:319-26.
4. Temple ME, Robinson RF, Miller JC, Hayes JR, Nahata MC. Frequency and preventability of adverse drug reactions in paediatric patients. Drug Saf. 2004;27:819-29.
5. van den Bemt PM, Egberts TC, de Jong-van den Berg LT, Brouwers JR. Drug-related problems in hospitalised patients. Drug Saf. 2000;22:321-33.
6. Kanjanarat P, Winterstein AG, Johns TE, Hatton RC, González-Rothi R, Segal R. Nature of preventable adverse drug events in hospitals: A literature review. Am. J Health-Syst Pharm. 2003;60:1750-9.
7. Nebecker JR, Barach P, Samore MH. Clarifying adverse drug events: A clinician´s guide to terminology, documentation and reporting. Ann Intern Med. 2004;140:795-801.
8. Johnson JA, Bootman JL. Drug-related morbility and mortality: A cost of illness model. Arch Int Med. 1995;155:1949-56.
9. Montoya G. Programa de detección de eventos adversos asociados a la administración de tramadol y dipirona en un hospital de alta complejidad. (trabajo de grado). Bogotá, D.C.: Universidad Nacional de Colombia; 2008. p. 46.
10. Parra MF. Programa de detección de eventos adversos asociados a la administración de heparina y warfarina en un hospital de alta complejidad (trabajo de grado). Bogotá, D.C.: Universidad Nacional de Colombia; 2008. p. 79.
11. Rehan HS, Chopra D, Kakkar AK. Physician's guide to pharmacovigilance: Terminology and causality assessment. Eur J Intern Med. 2009;20:3-8.
12. Committee of Experts on Management of Safety and Quality in Health Care (SP-SQS). Expert Group on Safe Medication Practices. 2005. Glossary of terms related to patient and medication safety. Genova: World Health Organization; 2005. Fecha de consulta: 14 de enero de 2010. Disponible en: http://www.who.int/patientsafety/highlights/COE_patient_and_medication_safety_gl.pdf.
13. Uppsala Monitoring Centre. The use of the WHO-UMC system for standardized case causality assessment. Genova: World Health Organization. Fecha de consulta: 14 de enero de 2010. Disponible en: www.who-umc.org/graphics/4409.pdf.
14. Hartwig S, Siegel J, Schneider P. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm. 1992;49:229-32.
15. Uppsala Monitoring Centre. Glossary of terms used in pharmacovigilance. Genova: World Health Organization; 2006. Fecha de consultado: 14 de enero de 2010. Disponible en: http://www.who-umc.org/graphics/15338.pdf.
16. Banco de la República de Colombia. Series estadísticas. 2007 Fecha de consulta: 17 de abril de 2008. Disponible en: http://www.banrep.gov.co/series-estadisticas/see_ts_cam.htm.
17. Bates DW, Miller EB, Cullen DJ, Burdick L, Williams L, Laird N, et al. Patient risk factors for adverse drug events in hospitalized patients. Arch Intern Med. 1999;159:2533-60.
18. Tribiño G, Maldonado C, Segura O, Díaz J. Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá. Biomédica. 2006;26:31-41.
19. Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: A prospective analysis of 3,695 patient-episodes. PLoS One. 2009;4:e4439.
20. Ajayi F, Sun H, Perry J. Adverse drug reactions: A review of relevant factors. J Clin Pharmacol. 2000;40:1093-101.
21. Krahenbuhl-Melcher A, Schlienger R,Lampert M, Haschke M, Dreive J, Krahenbuhd S. Drug-related problems in hospitals. A review of the recent literature. Drug Saf. 2007;30:379-407.
22. Gholami K, Shalviri G. Factors associated with preventability, predictability, and severity of adverse drug reactions. Ann Pharmacother. 1999;33:236-40.
23. Winterstein AG, Hatton RC, González-Rothi R, Johns TE, Segal R. Identifying clinically significant preventable adverse drug events through a hospital's database of adverse drug reaction reports. Am J Health Syst Pharm. 2002;59:1742-9.
24. Comité de Consenso. Tercer Consenso de Granada sobre problemas relacionados con medicamentos (PRM) y resultados negativos asociados a la medicación (RNM). Ars Pharm. 2007;48:5-17.
25. Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277:307-31.
26. Lagnaoui F, Moore N, Fach L, Longy-Boursier M, Begaud B. Adverse drug reactions in a department of systemic diseases-oriented internal medicine: Prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol. 2000;55:181-6.
How to Cite
1.
Pinzón JF, Maldonado C, Díaz JA, Segura O. Direct costs and hospital morbimortality impact from preventable adverse drug events. biomedica [Internet]. 2011 Mar. 31 [cited 2024 May 11];31(3):307-15. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/320
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