Schwerwiegende Arzneimittelnebenwirkungen von Phenprocoumon: stationäre Kosten der gastrointestinalen Blutungen und Einsparungspotentiale

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Abstract

Background and Objective:

Adverse drug reactions (ADR) are appreciably harmful or unpleasant effects, resulting from an intervention related to the use of a medicinal product, with a high burden for patients and considerable economic consequences. Comprehensive pharmacoeconomic evaluations of ADR are quite rare in Germany. It is the aim of this study to determine the hospital costs of gastrointestinal bleeding effects among users of phenprocoumon. Furthermore, based on calculations of the costs of genotyping and of new drugs like dabigatran, and also on information about patient self-management (PSM), options for reducing the financial burden are investigated.

Methods:

The study is based on all patients suffering from ADR included in the database of the Pharmacovigilance Center Greifswald between 2006 and 2009 (n=80). DRGs were calculated on the basis of information provided by the Hospital Information System of the University Medicine Greifswald, which can be regarded as a monopolist within a rural area. Costs of genotyping were calculated by direct assessment of the used resources.

Results:

Findings for the included 40 men and 40 women were quite similar. The average age was 74 ± 10 years. On average a patient spent 10 ± 7 days in hospital. All patients were multi-morbid (average number of diagnoses: 15 ± 7) and used several drugs (average number of co-medication: 9 ± 3). The hospital received on average €2821 per patient, with a range between €350 and €5900. The total costs of genotyping were €57. In the case of a dabigatran-based therapy avoiding ADR the corresponding DDD-based costs would rise from €0.21 to €7.78.

Conclusions:

ADR-related costs can be increased by a more stringent application of PSM. The costs of genotyping were quite low. Because false positive test results are quite rare, tests are profitable even at a low bleeding risk. The replacement of vitamin k antagonists by new drugs like dabigatran might first of all improve the corresponding therapy. Whether it is possible to decrease the corresponding economic burden or not depends first of all on the corresponding drug price level.

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