NEWS RELEASE For Release: 2 pm, MST, January 21, 1997
Contact: Jess Gomez, LDS Hospital (801) 321-2182
Embargoed by JAMA until 2 pm MST, Tuesday, January 21
LDS HOSPITAL STUDY FINDS THAT ADVERSE DRUG EVENTS COST THOUSANDS TO TREAT, PROLONG HOSPITALIZATIONS BY TWO DAYS, AND NEARLY DOUBLE RISK OF DEATH
SALT LAKE CITY, January 21 Adverse prescription drug reactions in hospital patients have long been known to cause problems. However, until now the cost and health-risk ramifications of adverse drug events (ADEs) have never been known.
In a new three-year study published in Wednesday's issue of The Journal of the American Medical Association, researchers from Intermountain Health Care's LDS Hospital found that adverse drug reactions on average prolong hospitalizations by nearly two days, cost $2,262 each to treat, and almost double the risk of death for patients.
"For several years investigators have studied the prevalence of adverse drug events and found they are a frequent problem. However, this is the first and largest study to examine and quantify the negative ramifications of these drug-related interactions," says David C. Classen, MD, MS, lead author of the study and a physician in the department of clinical epidemiology at LDS Hospital.
The study underscores the importance and value of computerized surveillance systems and intervention programs like the one in place at LDS Hospital, which helps combat this growing and costly problem, say the study authors.
Adverse drug events are complications patients experience due to various reactions and side-effects from prescription drugs. They can occur because of allergies or interactions between medications since many patients require between 10 to 40 different drugs during hospitalization. The LDS Hospital study found that 50 percent of adverse drug events are preventable.
"The reason that surveillance and intervention programs are absolutely essential is because up to half of all adverse drug events are preventable," says Dr. Classen. "If each event costs an additional $2,262 to treat, as our study shows, and an estimated 30 percent of all hospitalized patients in the United States experience a drug-reaction, then we are looking at significant opportunity to improve health care and curb unnecessary costs."
Dr. Classen notes that drug-related morbidity and mortality costs the U.S. more than $86 billion each year. "That's more than the total cost of cardiovascular care or diabetes care in the country," he adds.
Other members of the LDS Hospital research team include: Stanley L. Pestotnik, MS, Rph; R. Scott Evans, PhD; James F. Lloyd; and John P. Burke, MD.
Largest Study of its Kind. The researchers studied all patients who were admitted to 520-bed LDS Hospital from January 1, 1990, to December 31, 1993. They identified 1,580 patients who experienced adverse drug reactions ranging from itching, vomiting, rash, fever, and diarrhea to more complicated reactions including cardiac arrhythmia, hypotension, and bleeding. They then compared those patients to a control group that did not have an adverse drug event. The result: patients who experienced an adverse drug event on average had an increased length of stay of 1.91 days, an increased cost of $2,262, and an increased death rate of 1.88.
Using the sophisticated HELP bedside-computer system and electronic database at LDS Hospital that monitors for drug interactions, the research team was able to determine the most common types of reactions, the severity of the reactions, the drugs responsible for most of the events, and subsequent costs to treat those reactions.
Dr. Classen says that 92 percent of the drug reactions experienced by patients in the study were classified as moderate, meaning there was a change in care as a result of the event. The most common types of reactions were cardiac arrythmia, itching, nausea/vomiting, rash, dizziness, and fever. Drugs responsible for most of the reactions were morphine, digoxin, meperidine, and oxycodone.
Researchers found reactions that caused cardiac arrythmia, for example, cost an average of $4,410 to treat and resulted in an additional four days in the hospital. Fever initiated by a drug reaction cost more than $9,000 to treat and resulted in an extra 5.5 days in the hospital. Other reactions were less severe, but still costly. Patients who experienced itching were in the hospital for less than a day longer but still cost an additional $677 to treat. (See journal article for specific ADE costs.)
"When you multiply the number of adverse drug events that occur in American hospitals every year with the costs we have identified in our study, you begin to get an idea of the billions of dollars that could be saved by preventing these events altogether," says Dr. Classen. "At LDS Hospital, we have shown significant progress can be made toward this objective."
Preventing Adverse Drug Events. The researchers say they have reduced the occurrence and severity of complications from adverse drug events at LDS Hospital by doing the following:
providing timely feedback of ongoing ADEs to physicians to prevent progression of events to a more severe state implementing an effective program for tracking patient drug allergies
utilizing a program that automatically estimates daily kidney function of patients receiving antibiotics developing a computerized disease management program for antibiotic use that continually monitors patients and intervenes when there is a potential reaction
"What distinguishes our research from others is the fact that we have a proven track record of not only identifying adverse drug events, but actually preventing them," notes Dr. Classen.
The LDS Hospital study is one of three studies published in this week's issue of JAMA that focus on the issue of adverse drug events.
In an accompanying editorial, JAMA writes: "These articles illustrate the enormous power that hospital computing systems can bring to bear on the detection and definition of clinical events, both wanted and unwanted...in an era of constrained resources, it is vital to remember that ADEs in hospitals are common, costly, and preventable in many cases...Whatever the precise measure of their impact, their toll in human and fiscal terms is clearly large enough to justify commitment of hospital resources designed to reduce preventable ADEs to the lowest possible incidence."
LDS Hospital is part of the Intermountain Health Care system. Intermountain Health Care is a charitable, community-owned, nonprofit health care organization based in Salt Lake City that serves the health needs of Utah, Idaho, and Wyoming residents. The Intermountain Health Care system includes health insurance plans, 23 hospitals, clinics, and affiliated physicians.
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