Abstract
Adverse drug reactions (ADRs) may cause prolonged hospital admissions with high treatment costs. The burden of ADRs in children has never been evaluated in Nigeria. The incidence of pediatric ADRs and the estimated cost of treatment over an 18-month period were determined in this study. Prospective observational study on children admitted to the pediatric wards of the Lagos State University Teaching Hospital (LASUTH) in Nigeria, between July 2006 and December 2007. Each patient was assessed for ADRs throughout admission. Medical and non-medical costs to the hospital and patient were estimated for each ADR by reviewing the medical and pharmacy bills, medical charts and diagnostic request forms and by interviewing the parents. Cost estimates were performed in 2007 naira (Nigeria currency) from the perspectives of the hospital (government), service users (patients) and society (bearers of the total costs attributable to treating ADRs). The total estimated cost was expressed in 2007 United States dollars (USD). Two thousand and four children were admitted during the study; 12 (0.6%) were admitted because of ADRs and 23 (1.2%) developed ADR(s) during admission. Forty ADRs were suspected in these 35 patients and involved 53 medicines. Antibiotics (50%) were the most suspected medicines. Approximately 1.83 million naira (USD 15,466.60) was expended to manage all the patients admitted due to ADRs. Treating pediatric ADRs was very expensive. Pediatric drug use policies in Nigeria need to be reviewed so as to discourage self-medication, polypharmacy prescription and sales of prescription medicines without prescription.
Highlights
It has been estimated that fatalities directly attributable to Adverse drug reactions (ADRs) are the fourth to sixth leading cause of death in hospitals in the United States, exceeding deaths caused by pneumonia and diabetes.[3]
Despite the widespread impression that ADRs in hospitalized patients are costly because they require additional treatments and prolong the length of stay,[19] the exact cost attributed to ADRs has not been studied in children
609.27 ± 140.00 n = number of patients with ADRs; *the bed costs during admission; †the doctors’ and paramedics’ fees for managing the patient during admission; ‡ the costs of medicines obtained free of charge from the non-fee-paying pharmacy; §the costs of investigation done free of charge during hospital admission; ||Others refers to the mean cost of electricity, linen, water supplies, building and equipment depreciation, maintenance and medical record expenses incurred by the healthcare facility with inpatient expenses calculated at an 80% occupancy rate; ¶medication, diagnostic and procedure costs rendered free of charge to the patients during follow up visit; : 2007 naira (Nigerian currency)
Summary
Adverse drug reactions (ADRs) occur frequently and globally, accounting for a significant number of fatalities each year.[1,2] It has been estimated that fatalities directly attributable to ADRs are the fourth to sixth leading cause of death in hospitals in the United States, exceeding deaths caused by pneumonia and diabetes.[3]. The financial burden resulting from medicine-related morbidity and mortality is significant and has been conservatively estimated as United States dollars (USD) 30 billion annually in the United States.[9] Deaths resulting from ADRs have been reported in Nigeria.[2] In addition to the human costs, ADRs have a major impact on public health by imposing a considerable financial burden on society and the alreadystretched healthcare systems. Prevention of medicine-related morbidity and mortality has become an increasingly important requirement for reducing the morbidity, mortality and healthcare expenditure relating to ADRs. Estimates of treatment costs in hospital cost-effectiveness studies need to take the cost of medicine into consideration, but this should not be limited to its purchase price.[17] The real cost of a medicine must take into account the impact of ADRs potentially induced by this medicine.[18] Despite the widespread impression that ADRs in hospitalized patients are costly because they require additional treatments and prolong the length of stay,[19] the exact cost attributed to ADRs has not been studied in children. A few studies have examined the clinical and epidemiological trends of ADRs in Nigerian children,[2] but none have evaluated the cost of care associated with them
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