A cost-analysis of suspected adverse drug reactions in a hospital emergency ward

The main objective of this study was to analyse the minimum direct cost to the Public Health System (PHS) of diagnosing and treating those patients at tended to in the emergency ward (EW) for suspected adverse drug reaction (A DR). The cases were collected during March 1995 in the emergency ward of a 900-bed tertiary teaching hospital that covers 900,000 inhabitants. ADR was considered according to the WHO definition. The following EW costs were us ed: EW physician visit 78.5 ecus (1 ecu = 156 pesetas), thorax or abdomen r adiograph 21.5 ecus. computerized tomography 112.7 ecus, endoscopy 48 ecus, specialist physician visit 62 ecus. Three types of laboratory costs were c onsidered: block of biochemical tests 16 ecus, biochemical tests with blood count 22.5 ecus, and biochemical tests with blood count and coagulation st udy 41.6 ecus. Pharmacotherapy of the ADR and changes in patient's usual dr ug therapy due to ADR were estimated. For patients admitted in the hospital . a per day cost of 391 ecus was considered. A mean ADR cost per organ or s ystem affected (cutaneous, metabolic, gastrointestinal, nervous) was comput ed. The main conclusion of this study is that ADR, apart from inflicting damage on the patients, also incur PHS costs. The quantity of 42,732 ecus during the month of March, in a single hospital, can seem small when compared with the cost of some diseases such as AIDS or ischemic heart disease. But reme mbering that about 40% of all ADR attended to in hospitals is avoidable. a decrease of 40% could produce an annual saving of 205,216 ecus to the hospi tal, which is twice the annual budget of the Pharmacovigilance Centre of th e Basque Country. Pharmacovigilance centres should include cost analysis of ADR among their objectives, to provide health systems managers with enough information to implement those measures that will result in a better utili zation of the scarce resources of the Public Health System. Copyright (C) 1 999 John Wiley & Sons, Ltd.