THE HEALTH-CARE COST OF DRUG-RELATED MORBIDITY AND MORTALITY IN NURSING FACILITIES

Background: Preventable drug-related morbidity and mortality within nu rsing facilities represent a serious problem urgently requiring expert medical attention. The health care costs of drug-related problems can be both immense and avoidable. However, the research to date has been narrow in scope, focusing on the drug costs avoided and failing to co nsider the wider range of possible negative outcomes and potential dru g-related problems. Objectives: To develop a model of therapeutic outc omes resulting from drug therapy within nursing facilities, to estimat e the magnitude of the cost of drug-related morbidity and mortality wi thin nursing facilities in the United States, and to assess the impact of pharmacist-conducted, federally mandated, monthly, retrospective r eview of nursing facility residents' drug regimens in reducing the cos t of drug-related morbidity and mortality. Methods: Using decision ana lysis techniques, a probability pathway model was developed to estimat e the cost of drug-related problems within nursing facilities. An expe rt panel consisting of consultant pharmacists and physicians with prac tice experience in nursing facilities and geriatric care was surveyed to determine conditional probabilities of therapeutic outcomes attribu table to drug therapy. Health care utilization and associated costs de rived from negative therapeutic outcomes were estimated. Results: Base line estimates indicate that the cost of drug-related morbidity and mo rtality with the services of consultant pharmacists was $4 billion com pared with $7.6 billion without the services of consultant pharmacists . Conclusions: Drug-related morbidity and mortality in nursing facilit ies represent a serious economic problem. For every dollar spent on dr ugs in nursing facilities, $1.33 in health care resources are consumed in the treatment of drug-related problems. With the current federally mandated drug regimen review, it is estimated that consultant pharmac ists help to reduce health care resources attributed to drug-related p roblems in nursing facilities by $3.6 billion.