drugs do much more damage than illegal drugs.
Medscape Pharmacists, 2001
The Role of the Community Pharmacist in
Identifying, Preventing, and Resolving Drug-Related Problems
Jennifer Cerulli, PharmD, BCPS
It is estimated that
3% to 10% of hospital admissions are a consequence of drug-related morbidity
and mortality, and half of those admissions are preventable.
In 1995, the direct annual cost spent on preventable drug-related
morbidity and mortality in the US ambulatory population was
estimated to be $76.6 billion dollars; in 2000, the amount exceeded
$177.4 billion. These preventable negative patient outcomes
and their associated costs have caught the attention of patients, healthcare
professionals, and governmental agencies. Drug-related morbidity and mortality
often are preceded by a drug-related problem. Drug-related problems have
been defined as events or circumstances involving a patient's drug treatment
that actually, or potentially, interfere with the achievement of an optimal
outcome. Most drug-related problems can be assigned to 1 of 8 categories:
|Unnecessary drug therapy (drug without
|Untreated indication (indication without
|Improper drug selection
|Adverse drug reaction
|Failure to receive drug (inappropriate
See the full
The failed anti-recreational-drug
Federal Police State activities in the US cost ~ $12
billion a year with no measure of any "effectiveness", and the
rate for the US is the highest of any industrialized country: more
than 1/2% of the entire US population.
Ignoring the iatrogenic pharmaceutical drug
deaths, also much higher than recreational drug deaths, the $177 billion
lost yearly in the pharmaceutical drug disaster, however, costs ~ 15
times as much, and indicates that the wrong people are in jail.
Drug-Related Morbidity and Mortality: Updating
the Cost-of-Illness Model
J Am Pharm Assoc. 2001;41:192-9.
Frank R. Ernst and Amy J. Grizzle
Objective: To update the 1995
estimate of $76.6 billion for the annual cost of drug-related morbidity
and mortality resulting from drug-related problems (DRPs) in the ambulatory
setting in the United States to reflect current treatment patterns and
Design: For this study, we employed the decision-analytic
model developed by Johnson and Bootman. We used the model's original design
and probability data, but used updated cost estimates derived from the
current medical and pharmaceutical literature. Sensitivity analyses were
performed on cost data and on probability estimates.
Setting: Ambulatory care environment in the United States
in the year 2000. Patients and Other Participants: A hypothetical cohort
of ambulatory patients. Main Outcome Measures: Average cost of health
care resources needed to manage DRPs.
Results: As estimated using the decision-tree model, the mean
cost for a treatment failure was $977. For a new medical problem, the
mean cost was $1,105, and the cost of a combined treatment failure and
resulting new medical problem was $1,488. Overall, the cost of drug-related
morbidity and mortality exceeded $177.4 billion in 2000. Hospital
admissions accounted for nearly 70% ($121.5 billion) of total costs, followed
by long-term-care admissions, which accounted for 18% ($32.8 billion).
Conclusion: Since 1995, the costs associated with DRPs have more than
doubled. Given the economic and medical burdens associated with DRPs,
strategies for preventing drug-related morbidity and mortality are urgently
Frank R. Ernst, PharmD, is an Eli Lilly and Company Health
Outcomes Fellow; Amy J. Grizzle, PharmD, is assistant director, Center
for Health Outcomes and PharmacoEconomic Research, College of Pharmacy,
University of Arizona, Tucson. Correspondence: Frank R. Ernst, PharmD,
College of Pharmacy, University of Arizona, P.O. Box 210207, Tucson, AZ
85721-0207. Fax: 520-626-3386. E-mail: Ernst@Pharmacy.Arizona.edu.