The study estimated the cost of managing health problems related to drugs that led to emergency department visits at a large teaching hospital in Brazil. Of the 535 patients interviewed, 14.6% sought emergency care due to drug-related morbidity. The average treatment cost was $812.38 per patient, with a mean hospital stay of 5.7 days. The total estimated annual cost of treating these patients ranged from $1.043 million in the best-case scenario to $12.989 million in the worst-case scenario. Non-adherence, adverse drug reactions, and incorrect dosing were the leading causes of costs. Reducing preventable drug-related morbidity could help lower healthcare costs.

1. The Cost Of Drug-Related Morbidity
That Lead To Emergency Visits In A
Brazilian Hospital
Freitas G.1, Tramontina M.Y.1, Balbinotto
G.1, Hughes D.2, Heineck I.1
1Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
2Bangor University, Bangor, UK

2. Introduction
• Pharmacotherapy
when it fails and does not achieve optimal results or minimally
expected effect, the problems are described with differentexpected effect, the problems are described with different
terms:
– adverse drug events (ADEs),
– drug related problems (DRP),
– adverse drug reactions (ADRs),
– drug related morbidity (DRM).

3. Introduction
• 5% to 25% of all hospitalizations and more than 12% of visits
to emergency services are related to drugs
• 50% to 70% of cases are preventable
Zed PJ et al. The Journal of Pediatrics. 2013;163(2):477-83

4. Introduction
• DRPs include 28% of emergency cases
– 24% result in hospital admission
• 4/10 emergency medical services do not associate these visits
Patel P & Zed PJ. Pharmacotherapy. 2012;22: 915–923
• 4/10 emergency medical services do not associate these visits
to drug related morbidity
– Patients are inappropriately managed
Hohl CM et al. Annals of Emergency Medicine. 2010;55:493-502

5. Introduction
• For each US$ 1.00 spent on drugs, US$ 1.33 spent to treat
problems related to drugs
• According to the World Health Organization, 50% of all
medicines are prescribed, dispensed or used inappropriately
Johnson JA & Bootman JL: Arch Intern Med 1995, 155:1949-1956.
medicines are prescribed, dispensed or used inappropriately
• The cost of drugs related morbidity and mortality was
estimated at US$289 billion in the United States.
New England Healthcare Institute (NEHI). Thinking Outside the Pillbox: A
Systemwide Approach to Improving Patient Medication Adherence for Chronic
Disease. 2009.

6. Aim
• The aim of this work is to estimate the cost of managing
health problems related to drugs that lead to visits to the
emergency department of a large teaching hospital inemergency department of a large teaching hospital in
southern Brazil.

7. Methods
• Cross- sectional study.
• Data collection: medical records and interview.
• From all patients that sought emergency services over a six-
month period in a large teaching hospital in Brazil, 535 were
interviewed and those with DRM were identified using ainterviewed and those with DRM were identified using a
validated questionnaire
• Micro-costing analysis
• Sensitivity analysis (emergency room visits rates due to DRM
reported in the literature)
• All costs are presented in 2014 US$ (US$1=R$2.70)

8. Results
• 14.6% of patients sought emergency care due to DRM
– 58.9% of DRMs were considered preventable
• Mean treatment costs were US$812.38 ± 1,417 (range
US$16.04 to 9,832)US$16.04 to 9,832)
• Mean inpatient length of stay of DRM patients was 5.7 ± 8.4
days

9. Results
• Dividing the total expense for the causes of DRM:
16,9%
6,9%
36,9%
Non-adherence
ADR
Incorrect dose
Others
39,3%

10. Results
• Annual total treatment costs of US$6.773 million.
• Sensitivity analysis
– US$1.043 million in the best-case scenario
– US$12.989 milion at worst, per year– US$12.989 milion at worst, per year
% of patients that look for emergency
service because of DRM*
Best case scenario
(2.25%)
Worst case
scenario (28.1%)
Rodríguez-Monguió R, Otero MJ, Rovira J.Assessing the economic impact of
adverse drug effects. Pharmacoeconomics. 2003;21(9):623-50.

11. Conclusion
• DRM that leads to the search for emergency services are
frequent and generate a significant economic impact to the
hospital.
• The estimated annual cost for treating these patients is• The estimated annual cost for treating these patients is
around US$ 6.7 million, ranging from US$ 1.1 million to US$
13 million
• Much of this resource is spent to treat preventable cases of
DRM, which represents a great waste of resources.

12. Conclusion
• Adverse drug reactions and the non-adherence to treatment
are important causes of morbidity and cost to the health
service.
• Educating patients about the correct use of their medications,
identify possible adverse events and to monitor therapeutic
outcomes could reduce queues in emergencies,
hospitalizations , absenteeism and consequently costs for the
hospital, the health system and society.

13. grmf.pharma@gmail.com