This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (415)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Cost-of-Illness Model

Jeffrey A. Johnson, MSc; J. Lyle Bootman, PhD

Arch Intern Med. 1995;155(18):1949-1956.

Abstract
Background
Preventable drug-related morbidity and mortality represent a serious medical problem that urgently requires expert attention. The costs to society of the misuse of prescription medications, in terms of morbidity, mortality, and treatment, can be immense. To date, research has primarily documented increased rates of hospitalization secondary to medication noncompliance and/or adverse drug effects.

Objectives
To develop a conceptual model of drug-related morbidity and mortality, and to estimate the associated costs in the ambulatory setting in the United States.

Methods
A probability pathway model was developed to estimate the cost of drug-related morbidity and mortality in the United States. Pharmacist practitioners were surveyed to determine conditional probabilities of therapeutic outcomes owing to drug therapy. Health care utilization and associated costs owing to negative therapeutic outcomes were estimated.

Results
Drug-related morbidity and mortality was estimated to cost $76.6 billion in the ambulatory setting in the United States. The largest component of this total cost was associated with drug-related hospitalizations. When assumptions of the model were varied, the estimated cost ranged from a conservative estimate of $30.1 to $136.8 billion in a worst-case scenario.

Conclusions
The cost of drug-related morbidity and mortality in the ambulatory setting in the United States is considerable and should be considered in health policy decisions with regard to pharmaceutical benefits. Policies and services should be developed to reduce and prevent drug-related morbidity and mortality.

(Arch Intern Med. 1995;155:1949-1956)

Author Affiliations
From the Center for Pharmaceutical Economics, College of Pharmacy, The University of Arizona, Tucson.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

An Empirical Model to Estimate the Potential Impact of Medication Safety Alerts on Patient Safety, Health Care Utilization, and Cost in Ambulatory Care
Weingart et al.
Arch Intern Med 2009;169:1465-1473.
ABSTRACT | FULL TEXT  

A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 Years or Older: A Randomized Controlled Trial
Gillespie et al.
Arch Intern Med 2009;169:894-900.
ABSTRACT | FULL TEXT  

Effects of an integrated medicines management program on medication appropriateness in hospitalized patients
Burnett et al.
Am J Health Syst Pharm 2009;66:854-859.
ABSTRACT | FULL TEXT  

Effect of a Pharmacist on Adverse Drug Events and Medication Errors in Outpatients With Cardiovascular Disease
Murray et al.
Arch Intern Med 2009;169:757-763.
ABSTRACT | FULL TEXT  

Multiple toxic effects of low-dose methotrexate in a patient treated for psoriasis
Bookstaver et al.
Am J Health Syst Pharm 2008;65:2117-2121.
ABSTRACT | FULL TEXT  

The Iowa Continuity of Care study: Background and methods
Carter et al.
Am J Health Syst Pharm 2008;65:1631-1642.
ABSTRACT | FULL TEXT  

Medication Errors in Pediatric Inpatients: Prevalence and Results of a Prevention Program
Otero et al.
Pediatrics 2008;122:e737-e743.
ABSTRACT | FULL TEXT  

Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study
Zed et al.
CMAJ 2008;178:1563-1569.
ABSTRACT | FULL TEXT  

Evaluation of an Electronic Critical Drug Interaction Program Coupled with Active Pharmacist Intervention
Humphries et al.
The Annals of Pharmacotherapy 2007;41:1979-1985.
ABSTRACT | FULL TEXT  

Survey of Drug-Related Problems Identified by Community Pharmacies
Hammerlein et al.
The Annals of Pharmacotherapy 2007;41:1825-1832.
ABSTRACT | FULL TEXT  

Simplified Pharmacoeconomics of Critical Care and Severe Sepsis
Ernst et al.
J Intensive Care Med 2007;22:283-293.
ABSTRACT  

Admissions to a medical intensive care unit related to adverse drug reactions
Rivkin
Am J Health Syst Pharm 2007;64:1840-1843.
ABSTRACT | FULL TEXT  

Potential drug-drug interactions within Veterans Affairs medical centers
Mahmood et al.
Am J Health Syst Pharm 2007;64:1500-1505.
ABSTRACT | FULL TEXT  

The Utility of Adding Retrospective Medication Profiling to Computerized Provider Order Entry in an Ambulatory Care Population
Glassman et al.
J. Am. Med. Inform. Assoc. 2007;14:424-431.
ABSTRACT | FULL TEXT  

ASHP Long-Range Vision for the Pharmacy Work Force in Hospitals and Health Systems: Ensuring the Best Use of Medicines in Hospitals and Health Systems
Am J Health Syst Pharm 2007;64:1320-1330.
FULL TEXT  

Medication errors in inpatient pharmacy operations and technologies for improvement
Kuiper et al.
Am J Health Syst Pharm 2007;64:955-959.
FULL TEXT  

Drug-Induced Sweet's Syndrome
Thompson and Montarella
The Annals of Pharmacotherapy 2007;41:802-811.
ABSTRACT | FULL TEXT  

Provision of pain management by a pharmacist with prescribing authority
Dole et al.
Am J Health Syst Pharm 2007;64:85-89.
ABSTRACT | FULL TEXT  

Reimbursement for clinical services provided by pharmacists: What are we doing wrong?
Dole and Murawski
Am J Health Syst Pharm 2007;64:104-106.
FULL TEXT  

GI Risk Factors and Use of GI Protective Agents Among Patients Receiving Nonsteroidal Antiinflammatory Drugs
Harris et al.
The Annals of Pharmacotherapy 2006;40:1924-1931.
ABSTRACT | FULL TEXT  

Medication management assessment for older adults in the community.
Orwig et al.
Gerontologist 2006;46:661-668.
ABSTRACT | FULL TEXT  

Risk Reduction for Adverse Drug Events Through Sequential Implementation of Patient Safety Initiatives in a Children's Hospital
Leonard et al.
Pediatrics 2006;118:e1124-e1129.
ABSTRACT | FULL TEXT  

Compelling features of a safe medication-use system.
Kelly and Rucker
Am J Health Syst Pharm 2006;63:1461-1468.
FULL TEXT  

Enhanced Xenobiotic-Induced Hepatotoxicity and Kupffer Cell Activation by Restraint-Induced Stress
Panuganti et al.
J. Pharmacol. Exp. Ther. 2006;318:26-34.
ABSTRACT | FULL TEXT  

Adverse Drug Event Reporting in Intensive Care Units: A Survey of Current Practices
Kane-Gill and Devlin
The Annals of Pharmacotherapy 2006;40:1267-1273.
ABSTRACT | FULL TEXT  

Patient Safety and Quality Improvement Act of 2005
Fassett
The Annals of Pharmacotherapy 2006;40:917-924.
ABSTRACT | FULL TEXT  

Role of Pharmacist Counseling in Preventing Adverse Drug Events After Hospitalization.
Schnipper et al.
Arch Intern Med 2006;166:565-571.
ABSTRACT | FULL TEXT  

Psychiatric genetics - the new era: genetic research and some clinical implications
Prathikanti and Weinberger
Br Med Bull 2005;73-74:107-122.
ABSTRACT | FULL TEXT  

What is the patient really taking? Discrepancies between surgery and anesthesiology preoperative medication histories
Burda et al.
Qual Saf Health Care 2005;14:414-416.
ABSTRACT | FULL TEXT  

Racializing Drug Design: Implications of Pharmacogenomics for Health Disparities
Lee
AJPH 2005;95:2133-2138.
ABSTRACT | FULL TEXT  

Identification of Inappropriate Drug Prescribing by Computerized, Retrospective DUR Screening in Korea
Yeom et al.
The Annals of Pharmacotherapy 2005;39:1918-1923.
ABSTRACT | FULL TEXT  

Drug-Related Visits to the Emergency Department
Zed
Journal of Pharmacy Practice 2005;18:329-335.
ABSTRACT  

Documentation of pharmacist interventions in the emergency department
Ling et al.
Am J Health Syst Pharm 2005;62:1793-1797.
FULL TEXT  

Patients' Understanding of and Compliance With Medications: The Sixth Vital Sign?
Rosenow
Mayo Clin Proc. 2005;80:983-987.
 

Accuracy of adverse-drug-event reports collected using an automated dispensing system
Romero and Malone
Am J Health Syst Pharm 2005;62:1375-1380.
ABSTRACT | FULL TEXT  

Factors predictive of intravenous fluid administration errors in Australian surgical care wards
Han et al.
Qual Saf Health Care 2005;14:179-184.
ABSTRACT | FULL TEXT  

A Trial of Automated Decision Support Alerts for Contraindicated Medications Using Computerized Physician Order Entry
Galanter et al.
J. Am. Med. Inform. Assoc. 2005;12:269-274.
ABSTRACT | FULL TEXT  

Concealed Renal Insufficiency and Adverse Drug Reactions in Elderly Hospitalized Patients
Corsonello et al.
Arch Intern Med 2005;165:790-795.
ABSTRACT | FULL TEXT  

Impact of an interdisciplinary team on drug therapy outcomes in a geriatric clinic
Lam and Ruby
Am J Health Syst Pharm 2005;62:626-629.
FULL TEXT  

Oxymorphone Extended Release Does Not Affect CYP2C9 or CYP3A4 Metabolic Pathways
Adams et al.
J Clin Pharmacol 2005;45:337-345.
ABSTRACT | FULL TEXT  

Non-compliance: a side effect of drug information leaflets
Verdu and Castello
J. Med. Ethics 2004;30:608-609.
FULL TEXT  

A Trial of Automated Safety Alerts for Inpatient Digoxin Use with Computerized Physician Order Entry
Galanter et al.
J. Am. Med. Inform. Assoc. 2004;11:270-277.
ABSTRACT | FULL TEXT  

Comparison of Drug-Related Problems in Different Patient Groups
Viktil et al.
The Annals of Pharmacotherapy 2004;38:942-948.
ABSTRACT | FULL TEXT  

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: Results of a US Consensus Panel of Experts
Fick et al.
Arch Intern Med 2003;163:2716-2724.
ABSTRACT | FULL TEXT  

Quality Assessment of a Collaborative Approach for Decreasing Drug-Related Morbidity and Achieving Therapeutic Goals
Isetts et al.
Arch Intern Med 2003;163:1813-1820.
ABSTRACT | FULL TEXT  

Self-Administered Medication-Risk Questionnaire in an Elderly Population
Levy
The Annals of Pharmacotherapy 2003;37:982-987.
ABSTRACT | FULL TEXT  

Evaluating the Capability of Information Technology to Prevent Adverse Drug Events: A Computer Simulation Approach
Anderson et al.
J. Am. Med. Inform. Assoc. 2002;9:479-490.
ABSTRACT | FULL TEXT  

Medication Decisions--Right and Wrong
Stuart and Briesacher
Med Care Res Rev 2002;59:123-145.
ABSTRACT  

Decision support and safety of clinical environments
Morris
Qual Saf Health Care 2002;11:69-75.
ABSTRACT | FULL TEXT  

Nonspecific Medication Side Effects and the Nocebo Phenomenon
Barsky et al.
JAMA 2002;287:622-627.
ABSTRACT | FULL TEXT  

Prevention of Chemotherapy Medication Errors
Kloth
Journal of Pharmacy Practice 2002;15:17-31.
ABSTRACT  

A 40-Year-Old Woman Who Noticed a Medication Error
Bates
JAMA 2001;285:3134-3140.
FULL TEXT  

Using Computerized Data to Identify Adverse Drug Events in Outpatients
Honigman et al.
J. Am. Med. Inform. Assoc. 2001;8:254-266.
ABSTRACT | FULL TEXT  

High Time for Action
Kallianpur et al.
NEJM 2001;344:48-51.
FULL TEXT  

To Err Is Human
Bootman
Arch Intern Med 2000;160:3189-3189.
FULL TEXT  

Discrepancies in the Use of Medications: Their Extent and Predictors in an Outpatient Practice
Bedell et al.
Arch Intern Med 2000;160:2129-2134.
ABSTRACT | FULL TEXT  

Adherent and Nonadherent Medication-Taking in Elderly Hypertensive Patients
Johnson et al.
Clin Nurs Res 1999;8:318-335.
ABSTRACT  

Assessment of Drug-Related Problems in Clinical Nutrition Patients
Cerulli and Malone
JPEN J Parenter Enteral Nutr 1999;23:218-221.
ABSTRACT  

The Safety of Newly Approved Medicines: Do Recent Market Removals Mean There Is a Problem?
Friedman et al.
JAMA 1999;281:1728-1734.
ABSTRACT | FULL TEXT  

Generic Substitution and Optimal Patient Care
Murphy
Arch Intern Med 1999;159:429-433.
FULL TEXT  

Medication Cost Information in a Computer-Based Patient Record System: Impact on Prescribing in a Family Medicine Clinical Practice
Ornstein et al.
Arch Fam Med 1999;8:118-121.
ABSTRACT | FULL TEXT  

Iatrogenic Diseases as a Reason for Admission to the Intensive Care Unit: Incidence, Causes, and Consequences
Darchy et al.
Arch Intern Med 1999;159:71-78.
ABSTRACT | FULL TEXT  

Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors
Bates et al.
JAMA 1998;280:1311-1316.
ABSTRACT | FULL TEXT  

Association Between Licensing Examination Scores and Resource Use and Quality of Care in Primary Care Practice
Tamblyn et al.
JAMA 1998;280:989-996.
ABSTRACT | FULL TEXT  

Confusion of Nelfinavir and Nevirapine
Max et al.
NEJM 1998;338:396-397.
FULL TEXT  

The Health Care Cost of Drug-Related Morbidity and Mortality in Nursing Facilities
Bootman et al.
Arch Intern Med 1997;157:2089-2096.
ABSTRACT  

Medication-Prescribing Errors in a Teaching Hospital: A 9-Year Experience
Lesar et al.
Arch Intern Med 1997;157:1569-1576.
ABSTRACT  

Meeting Patient Needs in Asthma Education
Swanson
Journal of Pharmacy Practice 1997;10:211-221.
ABSTRACT  

What Every Dermatologist Should Know About Homeopathy, Hormesis, and Pharmacological Inversion
Clement
Arch Dermatol 1997;133:245-245.
ABSTRACT  

Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality
Classen et al.
JAMA 1997;277:301-306.
ABSTRACT  

The Costs of Adverse Drug Events in Hospitalized Patients
Bates et al.
JAMA 1997;277:307-311.
ABSTRACT  

Adverse Medication Events: From Adverse Drug Reactions to Adverse Medication Events
Kelly
Journal of Pharmacy Practice 1996;9:219-219.