Economic Aspects of Antibacterial Adverse Effects

Abstract

The economic impact of adverse effects is often understated. Increased hospitalisations attributed to adverse drug reactions alone account for billions of dollars each year within the US healthcare system. Although most classes of antibacterials are well tolerated, severe reactions do occur and can add significantly to the cost of care. Among hospitalised patients, antibacterial adverse effects account for nearly 25% of adverse drug reactions. Published pharmacoeconomic data on direct and indirect costs of antibacterial adverse effects are lacking. The importance of determining the most cost-effective treatment regimen is becoming more apparent due to limited resources available within the healthcare system. When considering the cost of new antibacterials, a simple comparison of acquisition costs may not accurately reflect the true costs of treatment. A drug with a lower acquisition cost may be more toxic and/or less effective, resulting in higher complication rates and/or treatment failures, thus leading to a higher overall treatment cost. In addition, nephrotoxic agents such as aminoglycosides and vancomycin often require close monitoring of serum drug concentrations and creatinine levels, which also contributes to the total cost of therapy. Indirect costs as a result of reduced quality of life or loss of productivity are certainly not reflected in the acquisition costs of antimicrobials. Institutions must evaluate a drug's potential for causing and adverse event, among various other factors, when considering drugs for inclusion on their formularies. Drugs with good safety profiles may minimise hospitalisation or facilitate early discharge. Thus, the adverse effect profile of an antimicrobial agent can contribute significantly to its overall direct costs, primarily as a result of higher monitoring costs and additional days of hospitalisation. For example, in the US, the cost associated with adverse effects, such as nephrotoxicity, observed with aminoglycosides and vancomycin, may add approximately $US2500 per patient with nephrotoxicity (1990 values). Indirect costs can also be substantial as a result of reduced productivity. Many adverse effects of antibacterial agents are predictable and may be minimised with appropriate monitoring and care. This article reviews the pharmacoeconomic aspects of adverse effects associated with some of the more important antibacterial classes such as the beta-lactams, aminoglycosides, vancomycin, macrolides and fluoroquinolones.

WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan

“…In a few countries, antibiotic prescribing was higher such as in Kenya (73.4%) (Holloway and Henry 2014), Timor-Leste (70%) (Stanley Chindove and Martins 2012), and Sudan (70.4%) (Holloway and Henry 2014). Unnecessary prescribing of antibiotics is a worldwide problem that eventually leads to ADRs and frequent hospital admissions (Beringer et al 1998). …”

“…According to another estimate, 20–50% of antimicrobial utilization is inappropriate (Čižman 2003) and this has a significant effect on the quality of health services provided (Shao-Kang et al 1998), treatment expenses (Segade 2000) and frequency of adverse drug reactions (ADRs). It has also been estimated that around one quarter (25%) of total ADRs can be attributed to antimicrobial use (Beringer et al 1998). Despite these concerns, the most alarming problem associated with irrational prescribing of antimicrobials is the development of resistance (Dellit et al 2007).…”

Safety of Newer Parenteral Antibiotics

“…Among hospitalized patients, antibacterials account for nearly 25% of drug-related adverse events [8]. Many adverse effects are common to a particular drug class, whereas some are limited to a particular agent.…”

“…Adverse effects of antibiotics are variable and can include phlebitis, hypersensitivity reactions, direct effects on tissues and organ systems, changes in microbial flora, and adverse interactions with other drugs [9]. Many of these adverse effects are not life-threatening but can have important economic implications by increasing the number of therapeutic interventions needed and the duration of the hospital stay [8]. To minimize the potential for serious adverse effects, clinicians should know the which adverse effects are associated with the antibiotics selected for their patients.…”

Medication use in European primary care patients with lower respiratory tract infection: an observational study

“…4 This overuse of antibiotics has several downsides, including development of bacterial resistance, 5 side effects, 4,6 and costs. 6 Similarly, there is little conclusive evidence for benefits from symptomatic treatments, [7][8][9] which are often used inappropriately 10 and can cause side effects. 7,8 A systematic review on the effectiveness of OTC medications for acute cough found no benefit from codeine or antihistamines.…”