Costs of ADRs

1. Patient safety: an economic
perspective
Sinaa Alaqeel MSc, PhD
April 2017

2. How Hospitals Kill Our Loved Ones And Conceal It
Source: Katz, D. The Huffington Post, 2017
“Hospitals kill our loved ones at
times, despite hard work and good
intentions, and conceal it even from
themselves. It hides in plain sight; it
is business as usual. It is the
business of each of us to do all we
can to defend our loved ones from
that. It is the business of all of us to
change it”

3. ‫البغداد‬ ‫يوسف‬ ‫بن‬ ‫اللطيف‬ ‫عبد‬‫ي‬
1162-1231
http://www.jameslindlibrary.org/abd-al-latif-ibn-yusuf-al-baghdadi-13th-century-ce-7th-century-ah/

4. ‫البغداد‬ ‫يوسف‬ ‫بن‬ ‫اللطيف‬ ‫عبد‬‫ي‬
1162-1231
http://www.jameslindlibrary.org/abd-al-latif-ibn-yusuf-al-baghdadi-13th-century-ce-7th-century-ah/

5. ‫البغداد‬ ‫يوسف‬ ‫بن‬ ‫اللطيف‬ ‫عبد‬‫ي‬
1162-1231
http://www.jameslindlibrary.org/abd-al-latif-ibn-yusuf-al-baghdadi-13th-century-ce-7th-century-ah/

6. Relationship between adverse drug events (ADEs), potential ADEs, and medication errors
T Morimoto et al. Qual Saf Health Care 2004;13:306-314
A dose of non-critical medication such
as docusate is given several hours late
A dose of critical medication such as
an intravenous antibiotic is not given
An injury due to a medication—for
example, cough due to angiotensin
converting enzyme (ACE) inhibitors
A coma due to an overdose of a
sedative.
An injury of which the severity or duration could
have been substantially reduced if different
actions had been taken

7. 160 websites of organisations
involved in medication safety were
searched 33 organisations have
one or more definitions for
medication safety related terms.
Qual Saf Health Care 2005;14:358–363.
Multiplicity of medication safety terms, definitions
and functional meanings: when is enough enough?

8. • 44,000—98,000 deaths/year as a result
of medical errors that could have been
prevented
• 8th leading cause of death in US
• National Costs: $17 to $29 billion

9. 251 454 deaths/ year
3rd leading cause of death in the US
Total number of US hospital admissions in 2013
was 35 416 020
0.71 of admissions with a preventable lethal
adverse event

10. BMJ 2015;351:h3239
The proportion of avoidable deaths,
defined as those with at least a 50%
probability of avoidability, in view of
trained medical reviewers, was 3.6% (95%
confidence interval 3.0% to 4.3%)
JAMA 2001 Jul 25;286(4):415-20.
Estimating hospital deaths due to medical errors:
preventability is in the eye of the reviewer.
22.7% of active-care patient deaths were
rated, on a 5-point scale, as at least
possibly preventable by optimal care,
with 6.0% rated as probably or definitely
preventable.
Avoidability of hospital deaths and association with
hospital-wide mortality ratios: retrospective case
record review and regression analysis
Preventable deaths due to problems in care in English
acute hospitals: a retrospective case record review
study
Reviewers judged 5.2% (95% CI 3.8% to
6.6%) of deaths as having a 50% or
greater chance of being preventable.BMJ Qual Saf. 2012;21:737-45

11. Incidence of adverse events in public and
private hospitals in Riyadh: The ADESA study
• 4 hospitals in Riyadh (1 teaching, 2 governmental, 1 private)
• Incidence were identified by pharmacists and reviewed by a clinicians
• 3985 patients were followed
• 1531 incidence were identified (245 AED, 677 PADEs, 609 ME with
low risk)
• The incidence of ADEs was 6.1 per 100 admission (95%CI 5.4-6.9)
BMJ Open 2016

12. Disability-adjusted life-years (DALYs) lost and
source of the DALYs, in 2009
BMJ Qual Saf 2013;22:809–815.
*All DALY numbers are in thousands.
DALY=Years of life lost due to premature death+ Years lost due to disability

13. Studies that provide an estimation of the cost of adverse events/medication
errors
Studies that evaluate the cost of different strategies for preventing adverse
events/medication errors
Studies which consider both costs and benefits of a given patient safety practice, compared with the status
quo situation or at least one alternative strategy
Studies that evaluate the benefit of different strategies for preventing adverse events/medication
errors
Evaluation of the economic burden
Complete economic evaluations
Evaluation of the cost of patient safety practices
Evaluation of outcomes of patient safety practices

14. Economic evaluation in patient safety: a literature
review of methods
Databases: MEDLINE, NHS EED, and Econlit Plus a manual search of the reference lists of relevant papers
Period: 2000 -2010
Language: English and French
.
Evaluation of the economic burden (incremental costs) of AEs
(n=18): these studies provide an estimation of the cost of AEs
without looking at the cost of interventions for preventing
them.
Evaluation of the cost of patient safety practices (n=3): these
studies evaluate the cost of different strategies for preventing
AEs without establishing the cost of these safety problems
Complete economic evaluations (n=12): which consider both
costs and benefits of a given patient safety practice, compared
with the status quo situation or at least one alternative
strategy.
BMJ Qual Saf 2012;21:457-465.

15. A literature-based economic evaluation
of healthcare preventable adverse events
in Europe
• The cost of preventable adverse events is
estimated to be between 1.1 and 2.43% of total
health expenditure, 17–38 billion Euros in 2015.
• The total annual DALYs were calculated as 3.5
million DALYs, of which 1.5 million were assumed
to have been preventable.
Sources of data: MEDLINE, EMBASE and CINAHL were searched for studies in Europe estimating cost of adverse
events (AEs) and PAEs (2000–March 2016). Using data from the literature, they estimated PAE costs based on
national 2013 total health expenditure (THE) data reported by World HealthOrganization
International Journal for Quality in Health Care, 2017, 29(1), 9–18

16. Comparative economic analyses of patient safety
improvement strategies in acute care: a systematic
review
Databases: MEDLINE Plus a manual search of the reference lists of relevant papers
Period: 2000 -2011
Strategies: 15 patient safety target conditions and six improvement strategies was conducted..
Complete economic evaluations (n=5): that reported a total
of seven comparisons based on at least one clinical
effectiveness study of adequate methodological quality
BMJ Qual Saf 2012;21:448-456.
Pharmacist-led medication reconciliation, the Keystone ICU
intervention for central line-associatedbloodstream infections,
chlorhexidine for vascular catheter site care, and standard
surgical sponge counts were economically attractive strategies
for improving patient safety

17. A systematic review of observational studies evaluating
costs of adverse drug reactions
Databases: MEDLINE, Cochrane Library, and Embase
Period: 1995-2015
. 22 cohort studies (71.0%), 7 case–control studies (22.6%), and
2 studies based on pharmacovigilance databases of
spontaneously reported ADEs (6.4%).
A total of 29 (93.5%) studies evaluated “direct health care
costs”, and two studies (6.5%) issued both “direct and indirect
health care costs”
The costs of ADEs related to any drug occurring in
nonhospitalized patients has been estimated from €702.21 to
€40,273.08
Clinicoecon Outcomes Res. 2016; 8: 413–426.
The costs of ADEs that occurred during hospitalization varied
from €943.40 to €5,972.74

18. How are the costs of drug-related morbidity measured?:
a systematic literature review.
Databases: CINAHL, EMBASE and MEDLINE
Period: 1990-2011
.
29 studies included
18 studies measured either the total or attributable costs
of drug-related morbidity, while 7 studies estimated the
increased costs using matched controls or regression analyses.
Drug Saf. 2012 Mar 1;35(3):207-19
6 studies measured costs from a payer perspective, while the
other 23 measured costs to the hospital.
1 study included costs resulting after discharge, and discounted
future costs, while the remaining 28 studies measured costs
during the initial admission only and involved no adjustment
for timing of costs.

19. Direct and indirect costs for adverse drug events
identified in medical records across care levels, and their
distribution among payers
Sample and setting: a random sample of 5025 adults in a Swedish county
methods: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by
comparing costs among individuals with ADEs to costs among matched controls.
Costs for resource use caused by ADEs were €505 per patient
with ADEs (95% confidence interval €345-665), of which 38%
were indirect costs.
Res Social Adm Pharm. 2016 Nov 19.
Compared to matched controls, the costs attributable to ADEs
were €1631, of which €410 were indirect costs.
The local health authorities paid 58% of the costs caused by
ADEs.

20. Burden of hospitalizations related to adverse drug events
in the USA: a retrospective analysis from large inpatient
database.
Data sources: Healthcare Cost and Utilization Project's Nationwide Inpatient Sample dataset for the years
2008 to 2011
Methods: patients with ADE based on 537 Classification of Diseases-9 codes.
The total hospitalizations with ADE to be 9 440 757 patients
(6.28% of total) from 2008 to 2011
Pharmacoepidemiol Drug Saf. 2017 Feb 24
Steroids (14.49%), antineoplastic drugs (13.06%),
anticoagulants (11.33%), nonsteroidal anti-inflammatory drugs
(8.78%), and opiates/narcotics (6.48%) were the five most
common causes of ADE.
Patient with ADE stayed 1.89 days [95% confidence interval (CI)
(1.79-1.99); p < 0.001] longer, incurred $1851.44 [95%CI
($1613.90-$2088.96), p < 0.001] higher

21. The future
• Economic evaluation of ADEs is still a neglected necessity
• Economic evaluations of better quality
• Economic evaluation of wider perspective

22. ١-‫وضع‬‫اتيجية‬‫ر‬‫االست‬‫ها‬‫تطوير‬ ‫على‬ ‫العمل‬‫و‬ ‫المرضى‬ ‫لسالمة‬ ‫الوطنية‬.
٢-‫سالمة‬ ‫مجال‬ ‫في‬ ‫الطبية‬ ‫الممارسات‬‫و‬ ‫اءات‬‫ر‬‫اإلج‬‫و‬ ‫السياسات‬ ‫تطوير‬ ‫على‬ ‫العمل‬‫و‬ ‫الصحية‬ ‫األنظمة‬‫و‬ ‫للتشريعات‬ ‫المقترحات‬ ‫تقديم‬‫المرضى‬‫بالمنشآت‬
‫الصحية‬.
٣-‫الصحية‬ ‫بالمنشآت‬ ‫المرضى‬ ‫لسالمة‬ ‫الوضع‬ ‫حول‬ ‫التحليلية‬ ‫البحوث‬ ‫ذلك‬ ‫في‬ ‫بما‬ ،‫المرضى‬ ‫بسالمة‬ ‫المتعلقة‬ ‫اسات‬‫ر‬‫الد‬‫و‬ ‫البحوث‬ ‫اء‬‫ر‬‫إج‬‫ل‬‫إلى‬ ‫لوصول‬
‫الممارسات‬ ‫أفضل‬.
٤-‫المرضى‬ ‫سالمة‬ ‫لتعزيز‬ ‫المناسبة‬ ‫الحلول‬ ‫ووضع‬ ،‫أسبابها‬ ‫على‬ ‫التعرف‬‫و‬ ،‫الوطني‬ ‫ى‬‫المستو‬ ‫على‬ ‫الطبية‬ ‫األخطاء‬ ‫ومتابعة‬ ‫رصد‬‫العامل‬‫و‬‫المنشآت‬ ‫في‬ ‫ين‬
‫الصحية‬.
٥-‫بالمملكة‬ ‫الصحية‬ ‫المؤسسات‬ ‫كافة‬ ‫على‬ ‫وتعميمها‬ ‫البحوث‬‫و‬ ‫اسات‬‫ر‬‫الد‬ ‫ونتائج‬ ‫المتخصصة‬ ‫العلمية‬ ‫المجالت‬‫و‬ ‫الممارسات‬ ‫أفضل‬ ‫نشر‬‫في‬‫سالمة‬ ‫مجال‬
‫المرضى‬.
٦-‫المرضى‬ ‫وسالمة‬ ‫ألمان‬ ‫العامة‬ ‫الثقافة‬‫و‬ ‫الوعي‬ ‫زيادة‬ ‫على‬ ‫العمل‬.
٧-‫افق‬‫ر‬‫الم‬ ‫في‬ ‫المخاطر‬ ‫ة‬‫دار‬‫ا‬‫و‬ ‫المرضى‬ ‫بسالمة‬ ‫المتعلقة‬ ‫ات‬‫و‬‫الند‬‫و‬ ‫ات‬‫ر‬‫المؤتم‬‫و‬ ‫العمل‬ ‫وورش‬ ‫التعليمية‬‫و‬ ‫التدريبية‬ ‫ات‬‫ر‬‫الدو‬ ‫عقد‬‫الصحية‬.
٨-‫مع‬ ‫بالتنسيق‬ ‫الطبي‬ ‫للمجتمع‬ ‫بها‬ ‫المتعلقة‬ ‫النتائج‬ ‫ونشر‬ ‫وتحليلها‬ ‫وجمعها‬ ‫الطبية‬ ‫األخطاء‬ ‫عن‬ ‫لإلبالغ‬ ‫وطني‬ ‫وسجل‬ ‫نظام‬ ‫إنشاء‬‫ا‬‫ذات‬ ‫لجهات‬
‫العالقة‬.
٩-‫المرضى‬ ‫لسالمة‬ ‫السعودي‬ ‫المركز‬ ‫عمل‬ ‫مجال‬ ‫في‬ ‫العالمية‬‫و‬ ‫اإلقليمية‬‫و‬ ‫المحلية‬ ‫ات‬‫و‬‫الند‬‫و‬ ‫ات‬‫ر‬‫المؤتم‬ ‫في‬ ‫المشاركة‬.
١٠-‫المرضى‬ ‫سالمة‬ ‫نظم‬ ‫وتطوير‬ ‫ات‬‫ر‬‫المباد‬‫و‬ ‫الحلول‬ ‫بشأن‬ ‫المملكة‬ ‫في‬ ‫الصحية‬ ‫للمؤسسات‬ ‫الفنية‬ ‫ات‬‫ر‬‫االستشا‬‫و‬ ‫الدعم‬ ‫تقديم‬.
١١-‫ا‬ ‫اكات‬‫ر‬‫الش‬‫و‬ ‫االتفاقيات‬ ‫وعقد‬ ،‫المركز‬ ‫بعمل‬ ‫العالقة‬ ‫ذات‬ ‫الدولية‬‫و‬ ‫اإلقليمية‬‫و‬ ‫المحلية‬ ‫المؤسسات‬‫و‬ ‫المنظمات‬ ‫مع‬ ‫ات‬‫ر‬‫الخب‬ ‫وتبادل‬ ‫ن‬‫التعاو‬‫لمت‬‫بذلك‬ ‫علقة‬.
١٢-‫ي‬ ‫فيما‬ ً‫ا‬‫خارجي‬ ‫المملكة‬ ‫وتمثيل‬ ،‫التعليمات‬‫و‬ ‫اعد‬‫و‬‫للق‬ ً‫ا‬‫وفق‬ ،‫المركز‬ ‫اض‬‫ر‬‫أغ‬ ‫يحقق‬ ‫بما‬ ‫ى‬‫األخر‬ ‫الدول‬‫و‬ ‫المملكة‬ ‫بين‬ ‫التنسيق‬‫و‬ ‫ن‬‫التعاو‬‫بس‬ ‫تعلق‬‫المة‬
‫المرضى‬.
١٣-‫ال‬ ‫بسالمة‬ ‫المتعلقة‬ ‫ات‬‫ر‬‫بالمباد‬ ‫يتعلق‬ ‫فيما‬ ‫وعائالتهم‬ ‫المرضى‬‫و‬ ‫الخاص‬‫و‬ ‫الحكومي‬ ‫الصحي‬ ‫القطاع‬ ‫بين‬ ‫وتنسيق‬ ‫وصل‬ ‫كحلقة‬ ‫العمل‬‫مرضى‬.
١٤-‫الصحية‬ ‫المنشآت‬ ‫نحو‬ ‫المطلوبة‬ ‫اءات‬‫ر‬‫اإلج‬ ‫باتخاذ‬ ‫المختصة‬ ‫للجهات‬ ‫التوصية‬‫و‬ ،‫الخاصة‬‫و‬ ‫الحكومية‬ ‫الصحية‬ ‫المنشآت‬ ‫وتقييم‬ ‫متابعة‬‫المتهاونة‬
‫المرضى‬ ‫بسالمة‬.