Cost of Medication-related Problems

The cost of medication-related problems continues to rise. In human terms, the cost is reflected in increased cases of loss of function or death. The economic cost has risen from more than $76 billion in 1995¹ in noninstitutional settings to $177 billion in 2000.² This can be attributed to increases in:

• Number of medications used
  Older Americans consume more medications and have more chronic conditions than any other portion of the population. Adults over 65 make up 13 percent of the population, but account for 34 percent of all prescription medications and 42 percent of retail prescription expenditures.³ Hence, it may be safe to assume that a large number of medication-related problems would arise within this group.
   
• Costs of hospitalization and other treatments
  The 2001 Ernst study found that 70 percent of the cost of medication-related problems was because of hospitalization. The incidence of older adults hospitalized for a medication-related problem may differ according to study guidelines and how a problem is defined, but it generally ranges from approximately 5 percent to 20 percent. One study found that medication-related problems have led 63 percent of older adults to their physician's office.⁴ A recent study of emergency room visits by older adults found that over 10 percent of the visits stemmed from this type of problem, and the percentage of visits was higher when a greater number of medications were involved.⁵
   
• Increased development and cost of new medications
  Since 1992, there has been a 50 percent increase in the number of prescriptions filled, currently estimated at 3 billion a year.⁶ This increase is due in part to growing numbers of new drugs on the market, especially those targeting conditions of older individuals, and direct-to-consumer advertising of prescription medications.

¹ Johnson, J.A., and Bootman, J.L. (1995). "Drug-Related Morbidity and Mortality: A Cost-of-Illness Model." Archives of Internal Medicine 155:1949-56.

² Ernst, F.R., and Grizzle, A.J. (2001). "Drug-Related Morbidity and Mortality: Updating the Cost-of-Illness Model." Journal of the American Pharmaceutical Association 41:192-99.

³ Families USA Report (2000) "Cost Overdose: Growth in Drug Spending for the Elderly 1992-2010." Washington, DC: Families USA.

⁴ Hanlon, J.T., et al. (1997) "Adverse Drug Events in High Risk Older Outpatients." Journal of the American Geriatrics Society 45:945-48.

⁵ Hohl, C.M., et al. (2001). "Polypharmacy, Adverse Drug-related Events, and Potential Adverse Drug Interactions in Elderly Patients Presenting to an Emergency Department." Annals of Emergency Medicine 38:666-71.

⁶ PR Newswire (Aug.13, 2002) "In 2001 Retail Pharmacies Filled Over 3 Billion Prescriptions."