Evaluation of cost of treatment of drug‐related events in a tertiary care public sector hospital in Northern India: a prospective study

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Drug related events include ADRs, events due to patient or physician noncompliance, drug overdosage and drug interactions.• Economic burden of management of drug related events are substantial and include both direct and indirect costs.• Some data regarding cost of treatment of ADR exist from south and western India. WHAT THIS STUDY ADDS• An approximate cost of management of drug related events presenting to the emergency medical department in a tertiary care hospital over a period of 4 months.• Compares the cost incurred in a public sector hospital to the projected cost of management of same events in a private sector hospital.• Gives a rough estimate of economic burden on the health care system due to adverse drug events. AIMSDrug related events (DREs) contribute significantly to hospital admissions. These are largely preventable events and require optimum use of the therapeutic agents. The study was conducted to analyze the cost of treatment of DREs. PATIENTS & METHODSAll visits to medical emergency department of a tertiary care public sector hospital in northern India were recorded in a prospective, non-interventional manner over a period of 4 months. DREs were recognized and were followed up till their stay in the hospital. Data about the cost generating components of direct and indirect costs of treatment of DREs were collected. The projected cost of treatment of the same DREs in a private sector hospital was estimated and compared. RESULTSOut of 1833 admissions, 92(5.01%) were due to DREs. Maximum cases were due to non compliance (66%) followed by ADR (28%) and drug overdose(6%). The common DREs leading to ED visits were cerebrovascular accident(19.44%), followed by accelerated hypertension(18.36%) and diabetic ketoacidosis(14.04%). Total cost of management of all the 92 DREs in our hospital was calculated to be INR17,37,339(€30,215). The direct cost was INR1,72,961(€3008) and the approximate indirect cost was INR15,64, 378(€27, 206). The projected cost of management of all the 92 DREs was estimated to be INR63,63,872(€1,01, 676) in a private sector hospital. CONCLUSIONThe study shows that ADEs leading to emergency department visits and hospitalizations constitute a significant economic burden. Training of the patients and the prescribers may lessen the economic burden on the patient as well as the health care system.

Patterns of prescription drug use and incidence of drug–drug interactions in patients reporting to medical emergency

“…Drug use is associated with desired beneficial as well as adverse effects because of inherent properties of the molecule or drug–drug interactions (DDI). Inappropriate and irrational prescriptions leading to drug‐related events (DRE) were responsible for 0.2–21.7% of all hospital admissions in previous studies [1–3]. Also, previous studies have estimated €1 01 676 to be the cost of managing DRE in private‐sector hospitals in India [2].…”

Cost of Adverse Drug Reactions in a South Indian Tertiary Care Teaching Hospital

“…The cost appears low to the patient as most of the health care costs in the study hospital were covered under a charity fund and only minimal costs were directly borne by the patients and were reported in the study 16 . In a study on the adverse reactions in an intensive care unit of a private hospital in India, it was reported that the management of an average ADR cost US$1537 17 . In another study from India that studied admissions due to ADRs, the cost of hospitalizations was estimated to be US$150 per admission 18 .…”

The direct costs of drug-induced skin reactions

“…Direct costs were estimated at €32 per one patient, while indirect costs were much higher -€295. The direct costs of treatment in this case are relatively low because in public hospitals in India they are not accounted for during the initial 48 hours of hospitalisation [12].…”

“…Reviewing international publications and a growing interest in the economic component of ADRs treatment is observed in many countries [5,6]. In Poland, some clinical pharmacology centres evaluate the efficacy and costs of therapies in broad pharmacoeconomic evaluation programmes [7,8].…”