(240) Estimated Costs of Severe Adverse Drug Reactions Resulting in Hospitalization in The Veterans Health Administration

Publication Number: 914

Background: In the Veterans Health Administration (VHA), adverse drug reactions (ADR) are reported to the Veterans Affairs Adverse Drug Event Reporting System (VA ADERS). Reported events that result in hospitalization can be integrated with cost information to determine a cost per ADR which may benefit the organization when evaluating strategies to reduce adverse outcomes.

Objectives: To estimate the cost of an ADR that results in hospitalization.

Methods: This retrospective quality improvement study was performed utilizing ADRs reported as severe in VA ADERS from fiscal years 2014 to 2018. ADR reports submitted to VA ADERS for outpatients with a severe outcome and admitted to the hospital were eligible for review. Individual ADR reports (patient, drug, reaction/symptom and related information) from VA ADERS were evaluated for inclusion, and qualifying reports were matched to the VHA hospitalization and then paired with that patient’s total hospitalization costs. Each ADR suspect medication was paired with the reported reactions, and hospitalization costs were summarized using mean, median, and measures of variance (SD and IQR). Costs were adjusted to 2018 US dollars using the Consumer Price Index.

Results: In total, 5,113 ADR reports (4,880 patients) indicated the event resulted in hospitalization. The mean (SD) patient age was 67.7 (12.2) years; 94.6% were male and 53.7% were white. Of the 5,113 reports, 2,792 included 1 reaction, and 3,918 reports involved1 medication. The most commonly reported drug reaction pairs were angioedema with lisinopril (406 reports), hemorrhage with warfarin (311 ), and gastrointestinal hemorrhage with warfarin (246). Lowest median cost of hospitalization was associated with angioedema from hydrochlorothiazide/lisinopril at $6951. Hemorrhage with enoxaparin was associated with the highest median cost at $29,535.

Conclusions: Hospital costs may be used to estimate the cost avoidance related to interventions to reduce ADRs.