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Adverse Drug Events in U.S. Hospitals

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Adverse Drug Events in U.S. Hospitals

May 24, 2012

It may come as a surprise to most people that the FDA does not require drug manufacturers to test their products for their effects on our genes. As you will learn from this site, the consequences can be catastrophic. Adverse drug events can also include side effects due to unintentional overdosing by the patient as well as to incorrect prescribing by a physician. The rates of adverse drug events have increased over time—a trend that is likely to continue with the aging of the population, the growth in the number of such preexisting health problems as type 2 diabetes, and polypharmacy (drug-drug interactions).

A study published in the Journal of the American Medical Association brought to light the staggering number of adverse drug events that occur each year in the U.S.:

“If the findings of the present study are generalized to the population of all Medicare enrollees, then more than 1,900,000 adverse drug events—more than a quarter of which are preventable—occur each year among 38 million Medicare enrollees; furthermore, estimates based on our study suggest that there are in excess of 180,000 life threatening or fatal adverse drug events per year, of which more than 50% may be preventable.”

Although studies show that the older you are, the more likely you are to suffer a drug-related adverse event, almost half of all deaths from adverse drug events and over 60% of hospitalizations resulting from such events occur in people under the age of 60.

Here are the latest statistics I could locate on drug-related adverse outcomes that were seen in hospitals and emergency departments (ED) in 2008:

  • Warfarin, insulin, and digoxin together account for over one-third of emergency departments
  • In 2008, drug-related adverse outcomes were noted in nearly 1.9 million inpatient hospital stays (4.7 percent of all stays), and 838,000 treat-and-release ED visits (0.8 percent of all visits).
  • Over the five years between 2004 and 2008, there was a 52 percent increase in drug-related adverse outcomes in the inpatient setting—more than half of this increase was due to corticosteroids, anticoagulants, and sedatives and hypnotics.
  • Among treat-and-release ED visits involving drug-related adverse outcomes, analgesics and antibiotics were common causes of events for all age groups. Psychotropics were another common drug-related adverse outcome for all age groups younger than 65. Agents affecting the blood (such as anticoagulants) were a common drug-related adverse outcome for those 65 and older.

Factoid: Over 53 percent of all inpatient stays with a drug-related adverse outcome were for patients 65 or older. Only 18.5 percent of treat-and-release ED visits with a drug-related adverse outcome were for elderly patients.

Below is a summary from The April, 2011 Report: Medication-Related Adverse Outcomes in U.S. Hospitals and Emergency Departments, 2008

  • In 2008, drug-related adverse outcomes were noted in nearly 1.9 million inpatient hospital stays (4.7 percent of all stays), and 838,000 treat-and-release ED visits (0.8 percent of all visits).
  • Over the five years between 2004 and 2008, there was a 52 percent increase in drug-related adverse outcomes in the inpatient setting—more than half of this increase was due to corticosteroids, anticoagulants, and sedatives and hypnotics.
  • In the inpatient setting, corticosteroids, such as prednisone, caused 13.2 percent of all drug-related adverse outcomes.
  • Analgesics, antipyretics, and antirheumatics were the second most common general cause of drug-related adverse outcomes for both inpatient and treat-and-release ED events, accounting for 12.5 percent and 11.8 percent of events, respectively. Within this category, opiates were the most common specific cause of drug-related adverse outcomes, responsible for 5.6 percent of all inpatient events and 4.4 percent of treat-and-release ED events.
  • Over 53 percent of all inpatient stays with a drug-related adverse outcome were for patients 65 or older. Only 18.5 percent of treat-and-release ED visits with a drug-related adverse outcome were for elderly patients.
  • Among treat-and-release ED visits involving drug-related adverse outcomes, analgesics and antibiotics were common causes of events for all age groups. Psychotropics were another common drug-related adverse outcome for all age groups younger than 65. Agents affecting the blood (such as anticoagulants) were a common drug-related adverse outcome for those 65 and older.

 

After a bit more digging, I found these startling statistics:

Costs of Drug-Related Adverse Events

$177.4 billion — Ambulatory care 1

$20.0 billion — Acute care 2

$4.0 billion — Nursing facility care 3

TOTAL: $201.4 billion in direct medical costs per year

☆ Disclaimer: This is my informed opinion. I could be wrong. What do you think?

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References:

  1. Ernst FR, Grizzle AL. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc 2001;41:192-9.
  2. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse drug events prevention study group. JAMA 1997;277(4):307-11.
  3. Bootman JL, Harrison DL, Cox E. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med 1997;157: 2089-96.

 

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