Annual Cost of Rx Therapy Problems Placed at $77 Billion

Drug Topics, October 23, 1995, Michael F. Conlan

Pharmacy groups are applauding the release of a long-anticipated study on the staggering financial costs of drug-related treatment problems. The study viewed pharmaceutical care as a major way to reduce the estimated $76.6 billion annual toll directly associated with negative therapeutic outcomes resulting from drug therapy.

"The largest component of the total cost comprised drug-related hospitalization, that is, an estimated 8.76 million admissions at a cost of $47.7 billion annually, or approximately 62% of the total cost," wrote J. Lyle Bootman, dean of the University of Arizona's pharmacy school and Jeffrey A. Johnson, also of the university. "Based on 31.1 million hospital admissions in 1992, the number of admissions estimated from the model suggested that 28.2. of all hospital admissions were a result of drug-related morbidity and mortality."

Writing in the October 9 issue of the Archives of Internal Medicine, Bootman and Johnson also listed 3.15 million admissions to long-term care facilities at a cost of $14.4 billion; 115 million additional visits to physicians, nearly $7.5 billion; 17 million emergency visits, $5.3 billion; and 76.3 million more prescriptions, $1.93 billion.

The study estimated almost 200,000 deaths from untoward drug treatment, on which no cost figure was placed. It suggested that if lost economic productivity estimates were added to the direct-cost calculations, the total cost of all preventable drug use problems could be as high as $182 billion.

The study had been widely discussed in pharmacy circles since it was accepted for publication last winter. It was partially supported by a grant from the Coalition for Consumer Access to Pharmaceutical Care, which consists of the American Association of Colleges of Pharmacy, American College of Clinical Pharmacy, Academy of Managed Care Pharmacy, American Pharmaceutical Association, American Society of Consultant Pharmacists, American Society of Health-system Pharmacists, National Consumers League and the National Pharmaceutical Association.

"The new health-care system demands that consumers comply with very complicated instructions about their drug therapy, yet it has failed to provide the appropriate monitoring and support necessary to help consumers get well and avoid adverse drug effects," John A. Gans, APhA executive V.P. responded. "This is a problem, because there is no risk-free drug therapy. It is incumbent upon health-care practitioners, led by the profession of pharmacy, to build a support system to enable the public to gain the full value of their drug therapy and minimize the downside risk."

It's already happening in managed care, according to AMCP. Said president Allan Zimmerman, "In managed care systems across the country, pharmacists, physicians, and other providers are adopting new state-of-the-art methodologies, including drug formularies, quality improvement programs, and disease state management. Such methods allow caregivers to better monitor patients, track the progression of their illnesses, and prescribe the most appropriate treatments--all with the goal of improving patient outcomes."

The consumer access coalition said that in part of the study not published, the authors reported that $45.6 billion of the $76.6 billion could be eliminated and more then 120,000 patient deaths prevented if pharmacist services were more fully utilized in ambulatory settings. "Pharmacists help avoid potentially deadly and costly prescription drug misuses best when they are fully integrated as active participants on the patient care team, carefully reviewing each prescription for accuracy and appropriateness and providing each patient with expert one-on-one counseling about medication," the coalition said.