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Costs of ADRs


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Costs of ADRs

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Costs of ADRs

  1. 1. Patient safety: an economic perspective Sinaa Alaqeel MSc, PhD April 2017
  2. 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. 3. ‫البغداد‬ ‫يوسف‬ ‫بن‬ ‫اللطيف‬ ‫عبد‬‫ي‬ 1162-1231
  4. 4. ‫البغداد‬ ‫يوسف‬ ‫بن‬ ‫اللطيف‬ ‫عبد‬‫ي‬ 1162-1231
  5. 5. ‫البغداد‬ ‫يوسف‬ ‫بن‬ ‫اللطيف‬ ‫عبد‬‫ي‬ 1162-1231
  6. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 21. The future • Economic evaluation of ADEs is still a neglected necessity • Economic evaluations of better quality • Economic evaluation of wider perspective
  22. 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.