بستری های بیمارستانی قابل پیشگیری مربوط به دارو (HARM): مطالعه تجزیه و تحلیل هزینه هارم

Adverse drug events (ADEs) can cause serious harm to patients and can lead to hospitalization or even death. ADEs are a burden not only to patients and their relatives, but also to society and have the potential to involve high costs. To provide more information on the economic burden of preventable adverse drug events of outpatients, we performed a cost study on the data collected in the Hospital Admissions Related to Medication (HARM) study. In this study we examined the frequency, preventability, and risk factors for hospital admissions related to medication. Methods The average costs for a preventable medication-related hospital admission were calculated by summing the direct medical costs and the production losses of all the preventable admissions, taking into account the different types of hospitals (academic and general) and the age of the admitted patients. Results The average medical costs for one preventable medication-related hospital admission were €5461. The average production loss costs for one admission were €1712 for a person younger than 65 years of age. Combining the medical costs and the costs of production losses resulted in average costs of €6009 for one, potentially preventable, medication-related hospital admission for all ages. Conclusions The costs of potentially preventable hospital admissions related to medication are considerable. Therefore, patient safety interventions to prevent ADEs and hospital admissions may be cost-effective or even cost saving

Adverse drug events (ADEs) can cause serious harm to patients and can lead to hospitalization or even death [1] and [2]. Adverse drug events are not only a burden to patients and their relatives but also to society, potentially involving high costs [3], [4] and [5]. On one hand, improvement of medication safety and patient safety is a major concern to health care workers and policymakers and has the potential to reduce health care costs; however, increasing budgetary constraints often hamper investments in patient safety improvements. Thus, more insight into the costs of preventable hospital admissions may help to prioritize areas to improve patient safety from an economic perspective in addition to the patient and health care perspective. Some information is already available on costs associated with adverse events and preventable adverse events that occur inside hospitals. A study in the United States estimated the costs attributable to an ADE at $2595 for all ADEs and $4685 for preventable ADEs in 1997. Based on these costs and data about the incidence of ADEs, the authors extrapolated that the annual costs attributable to all ADEs and to preventable ADEs for a 700-bed teaching hospital would be $5.6 million and $2.8 million, respectively [3].The direct medical costs in Dutch hospitals [4] (total number of beds in The Netherlands: 54,353 [6]) were estimated at a total of €355 million for all adverse events (not just events caused by drugs) and €161 million for preventable adverse events in 2004, which is 1.1% of the expenses of the Dutch health care budget [7]. Information on costs of outpatient adverse drug events leading to hospital admissions is still lacking in The Netherlands, but some information is available from studies performed in the United States and the United Kingdom. Estimates of the costs of one medication-related hospital admission vary from US$1507 to US$8300 [8] and [9]. Exchanging UK£ into US$, a large study in the United Kingdom estimated these costs at the lower range of this interval. Patel et al. [1] also suggested that these admissions cost the NHS up to £466 (US$786; €542) million annually, which is 0.59% of the British health care budget [10]. Unfortunately, only direct medical costs were reported [11], and many of the published studies were either limited to only one [12] or two hospitals, individual units, or patient groups [8] and [13], or reported no information on preventable costs [14] and [15]. Given the wide range of costs mentioned in literature and the need for information on the economic burden of preventable adverse drug events of outpatients, we performed a cost analysis on the data we had previously collected in the Hospital Admissions Related to Medications (HARM) study [2]. The previous HARM study was a prospective, multicenter, case-control study in which we collected data on approximately 13,000 unplanned admissions in 21 hospitals in The Netherlands. Results revealed that 5.6% (n = 714) of hospital admissions were thought to be medication related. One-half of these (n = 332) were considered to be potentially preventable. In the current study, we present the total short-term costs associated with preventable medication-related hospital admissions. In addition, we report costs of different subgroups of admissions based on type of hospital, age, preventability, and reason of admission to gain further insight into the potential sizes and areas for cost savings attributable to possible strategies to prevent ADEs.

The cost estimates of potentially preventable hospital admissions related to medication are considerable. Insight into the subclasses of medication-related hospitalizations that are related with the highest costs offers a starting point for patient safety interventions, which may be cost-effective or even cost saving.