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Current Therapeutic Research, Clinical and Experimental logoLink to Current Therapeutic Research, Clinical and Experimental
. 2008 Apr;69(2):118–129. doi: 10.1016/j.curtheres.2008.04.005

Cost evaluation of adverse drug reactions in hospitalized patients in Taiwan: A prospective, descriptive, observational study

Agnes LF Chan 1,2, Haw Yu Lee 3, Chi-Hou Ho 1, Thau-Ming Cham 2, Shun Jin Lin 2,a
PMCID: PMC3969903  PMID: 24692791

Abstract

Background: Adverse drug reactions (AADRs) are a leading cause of morbidity and mortality. In the United States, ADR-related morbidity and mortality costs have been estimated at US $330 billion to US $1130 billion annually.

Objectives: The aim of this study was to evaluate the incidence of ADRs in Taiwan, to identify the drug classes that are most commonly related to ADRs, and to determine the direct medical costs to hospitals associated with prolonged hospitalizations due to ADRs.

Methods: In this prospective, descriptive, observational study, patients who experienced ADRs during their hospitalization at a Taiwan teaching hospital or who were admitted due to an ADR from January 1, 2002, through December 31, 2004, were included in the study. The patients were identified actively by clinical pharmacists and passively by physicians and nurses who reported ADRs. The World Health Organization (WWHO) definition of ADR severity was adopted, and degrees of probability for each ADR were determined using the Naranjo algorithm. The direct medical costs incurred to the hospital in the treatment of ADRs that prolonged hospitalization were calculated (ie, costs of emergency department [ED] visits, intensive care unit visits, extra days of hospitalization, monitoring and laboratory studies, pharmacist dispensing fees, physician fees, room charges, ED charges).

Results: During the study period, 43 of the 142,295 hospitalized patients (00.03%)) were admitted because of an ADR. A total of 564 (00.40%)) of the hospitalized patients were verified to have ADRs. Three hundred eighteen of the patients (56.44%) with ADRs were male and the overall mean (SD) age was 66(2) years. The most common drug classes associated with the ADRs were antibiotics (219 patients [38.8% ]), analgesics (62 [11.0%]), and cardiovascular agents (56 [9.9%]). The systems most commonly involved in ADRs were cutaneous (296 patients [52.5%]), hematologic (61 [10.8%]), and cardiovascular (54 [9.66%]). The causes of the ADRs were anaphylactic (464 patients [82.3%]), drug overdose (78 [13.8%]), and drug-drug interactions (22 [3.9%]). Of the ADRs, 474 (884.0%) were idiosyncratic type B reactions (predictable). ADR-related costs, estimated at US $3489/ADR, were mostly due to prolonged length of stay. Based on the WHO definition, of the 564 ADRs, 330 (58.5%) and 40 (7.1%) were classified as moderate and severe, respectively. Two patients died of ADRs associated with allopurinol.

Conclusion: In this hospital, 0.40% of patients were identified as having ADRs that were associated with high direct costs, mostly due to extended hospitalizations.

Key words: direct medical cost, adverse drug reactions

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Footnotes

Presented in part in poster form at the American Association of Colleges of Pharmacy Annual Meeting, July 14—18, 2007, Orlando, Florida.

References

  • 1.Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. JAMA. 1998;279:1200–1205. doi: 10.1001/jama.279.15.1200. [DOI] [PubMed] [Google Scholar]
  • 2.Bates DW. Drugs and adverse drug reactions. How worried should we be? JAMA. 1998;279:1216–1217. doi: 10.1001/jama.279.15.1216. [DOI] [PubMed] [Google Scholar]
  • 3.Beijer HJ, de Blaey CJ. Hospitalizations caused by adverse drug reactions (ADR): A meta-analysis of observational studies. Pharm World Sci. 2002;24:46–54. doi: 10.1023/a:1015570104121. [DOI] [PubMed] [Google Scholar]
  • 4.Pirmohamed M, James S, Meakin S. Adverse drug reactions as cause of admission to hospital: Prospective analysis of 18 820 patients. BMJ. 2004;329:15–19. doi: 10.1136/bmj.329.7456.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Onder G, Pedone C, Landi F. Adverse drug reactions as cause of hospital admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA) J Am Geriatr Soc. 2002;50:1962–1968. doi: 10.1046/j.1532-5415.2002.50607.x. [DOI] [PubMed] [Google Scholar]
  • 6.Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155:1949–1956. [PubMed] [Google Scholar]
  • 7.White TJ, Arakelian A, Rho JP. Counting the costs of drug-related adverse events. Pharmaco-Economics. 1999;15:445–458. doi: 10.2165/00019053-199915050-00003. [DOI] [PubMed] [Google Scholar]
  • 8.World Health Organization . Collaborating Centers for International Drug Monitoring. World Health Organization; Geneva, Switzerland: 1984. WHO publication DEM/NC/84.153(E) [Google Scholar]
  • 9.Wang HP, Chen HC, Hung YT. Presented at: The National Taiwan University Post-SAR Conference. January 2, 2004. The value of community: Prevention of infectious disease. Taipei, Taiwan. [Google Scholar]
  • 10.Nita Y, Plumridge RJ, Batty KT. Adverse drug reaction reporting in Australian Hospitals. Int J Pharm Pract. 2004;12:155–161. [Google Scholar]
  • 11.Naranjo CA, Busto U, Sellers EM. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–245. doi: 10.1038/clpt.1981.154. [DOI] [PubMed] [Google Scholar]
  • 12.Hartwig SC, Siegel J, Schneider PJ. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm. 1992;49:2229–2232. [PubMed] [Google Scholar]
  • 13.Rawlins MD, Thompson JW. Pathogenesis of adverse drug reactions. In: Davies DM, editor. Textbook of Adverse Drug Reactions. Oxford University Press; Oxford, United Kingdom: 1977. p. 10. [Google Scholar]
  • 14.Murphy BM, Frigo LC. Development, implementation, and results of a successful multidisciplinary adverse drug reaction reporting program in a university teaching hospital. Hosp Pharm. Hosp Pharm. 1993;1993;2828:1199–1204. 1199–1240. [PubMed] [Google Scholar]
  • 15.Bennett BS, Lipman AG. Comparative study of prospective surveillance and voluntary reporting in determining the incidence of adverse drug reactions. Am J Hosp Pharm. 1977;34:931–936. [PubMed] [Google Scholar]
  • 16.Keith MR, Bellanger McCleery RA, Fuchs JE., Jr Multidisciplinary program for detecting and evaluating adverse drug reactions. Am J Hosp Pharm. 1989;46:1809–1812. [PubMed] [Google Scholar]
  • 17.Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: A multicenter investigation. Age Ageing. 1980;9:73–80. doi: 10.1093/ageing/9.2.73. [DOI] [PubMed] [Google Scholar]
  • 18.Carbonin P, Pahor M, Bernabei R. Is age an independent risk factor of adverse drug reactions in hospitalized medical patients? J Am Geriatr Soc. 1991;39:1093–1099. doi: 10.1111/j.1532-5415.1991.tb02875.x. [DOI] [PubMed] [Google Scholar]
  • 19.van der Hooft CS, Sturkenboom MC, van Grootheest K. Adverse drug reaction-related hospitalizations: A nationwide study in The Netherlands. Drug Saf. 2006;29:161–168. doi: 10.2165/00002018-200629020-00006. [DOI] [PubMed] [Google Scholar]
  • 20.Ramesh M, Pandit J, Parthasarathi G. Adverse drug reactions in a South Indian hospital—their severity and cost involved. Pharmacoepidemiol Drug Saf. 2003;12:687–692. doi: 10.1002/pds.871. [DOI] [PubMed] [Google Scholar]
  • 21.Suh DC, Woodall BS, Shin SK, Hermes-De Santis ER. Clinical and economic impact of adverse drug reactions in hospitalized patients. Ann Pharmacother. 2000;34:1373–1379. doi: 10.1345/aph.10094. [DOI] [PubMed] [Google Scholar]
  • 22.Wolf R, Orion E, Marcos B, Matz H. Life-threatening acute adverse cutaneous drug reactions. Clin Dermatol. 2005;23:171–181. doi: 10.1016/j.clindermatol.2004.06.012. [DOI] [PubMed] [Google Scholar]
  • 23.Bordet R, Gautier S, Le Louet H. Analysis of the direct cost of adverse drug reactions in hospitalized patients. Eur J Clin Pharmacol. 2001;56:935–941. doi: 10.1007/s002280000260. [DOI] [PubMed] [Google Scholar]
  • 24.Dormann H, Muth-Selbach U, Krebs S. Incidence and costs of adverse drug reactions during hospitalization: Computerized monitoring versus stimulated spontaneous reporting. Drug Safety. 2000;22:161–168. doi: 10.2165/00002018-200022020-00007. [DOI] [PubMed] [Google Scholar]
  • 25.Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991;266:2847–2851. [PubMed] [Google Scholar]
  • 26.Prosser TR, Kamysz PL. Multidisciplinary adverse drug reaction surveillance program. Am J Hosp Pharm. 1990;47:1334–1339. [PubMed] [Google Scholar]

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