Qing-ping Shi, Xiao-dong Jiang, Feng Ding, Yan Liu, Mei-ling Yu, Jin-xiu Zhu, Shu-qiang Zhang
Department of Pharmacy, the first Affiliated Hospital of Bengbu Medical College, 287 Zhihuai Road, Bengbu 233004, China.
BMC Health Serv Res. 2014 Feb 17;14:73. doi: 10.1186/1472-6963-14-73.
Adverse drug reactions (ADRs) are a leading cause of morbidity in developed countries and represent a substantial burden on health-care resources. Many countries spent 15% to 20% of their hospital budgets to treat drug complications. However, few studies have measured the pharmacoeconomic effects of ADRs on hospitalized patients in China. The study estimates the costs of ADRs as identified from the spontaneous voluntary reports completed from healthcare professionals. To do so, we calculate these costs, determine the sum of Medicare payments and their proportion of total healthcare spending, and evaluate the incidence of ADRs, characteristics of hospitalized ADR patients, and outcomes of ADRs in China.
This retrospective survey studied patients who experienced ADRs during their hospitalization at a Chinese tertiary-care teaching hospital. The patients were divided into group A and group B according to general ADRs and serious ADRs in Provisions for Adverse Drug Reaction Monitoring and Reporting. The direct costs included treatment fees, inspection fees, laboratory fees, materials fees, bed charges, drug charges, nursing care, meals, and other expenses and the sunk-cost losses were calculated according to the hospital information system (HIS). Indirect costs of ADR treatment were calculated according to the human capital approach. The epidemiological characteristics of ADRs were evaluated.
2739 were diagnosed with ADR during the study period, which translates to an ADR rate of 0.81%. The total socioeconomic loss from 2739 cases of ADR was estimated at ¥817401.69, consisting of direct costs of ¥603252.81 and indirect costs of ¥214148.88. On average, the costs per patient amounted to ¥196.10 in group A, ¥7032.29 in group B. The sum of medicare payment and proportion were ¥219061.13 (65.23%) and ¥105422.02 (39.42%) in group A and B. The ADR incidence in old-age patients was significantly higher than in other age groups (P < 0.0001). The most common drug class associated with ADRs represented antibiotics (957 patients, 34.94%).
The costs of especially severe ADRs could not be ignored, and in this hospital 0.13% of patients were diagnosed with ADRs associated with relatively higher direct costs than who suffered from mild ADRs, largely due to extended hospitalization.
药物不良反应（ADR）是发达国家发病的主要原因，对卫生保健资源造成沉重负担。许多国家将15%至20%的医院预算用于治疗药物并发症。然而，在中国，很少有研究衡量ADR对住院患者的药物经济学影响。本研究通过医护人员填写的自发自愿报告估算ADR的成本。为此，我们计算这些成本，确定医疗保险支付的总和及其在医疗总支出中的比例，并评估中国ADR的发生率、住院ADR患者的特征以及ADR的转归。
这项回顾性调查研究了在中国一家三级甲等教学医院住院期间发生ADR的患者。根据《药品不良反应监测和报告管理办法》中一般ADR和严重ADR，将患者分为A组和B组。直接成本包括治疗费、检查费、化验费、材料费、床位费、药费、护理费、餐费和其他费用，沉没成本损失根据医院信息系统（HIS）计算。ADR治疗的间接成本根据人力资本法计算。评估ADR的流行病学特征。
研究期间共诊断出2739例ADR，ADR发生率为0.81%。2739例ADR造成的社会经济总损失估计为817401.69元，其中直接成本为603252.81元，间接成本为214148.88元。平均而言，A组每名患者的成本为196.10元，B组为7032.29元。A组和B组医疗保险支付总和及比例分别为219061.13元（65.23%）和105422.02元（39.42%）。老年患者的ADR发生率显著高于其他年龄组（P＜0.0001）。与ADR相关的最常见药物类别是抗生素（957例患者，34.94%）。
特别严重的ADR成本不容忽视，在这家医院，0.13%的患者被诊断为ADR，与轻度ADR患者相比，直接成本相对较高，这主要是由于住院时间延长。
