title: Modelling drug-related morbidity in Sweden using an expert panel of physicians.
abstract: OBJECTIVE
  In modelling studies using pharmacists' opinions, drug-related morbidity (DRM) and preventable DRM have been more common than in observational studies, and the resulting costs are extensive. Modelling studies' estimates may vary depending on informants' profession. The purpose of this modelling study was to estimate the proportion of patients with DRM and preventable DRM and the cost of illness (COI) of DRM in Sweden based on physicians' expert opinions.
  
  
  METHODS
  A conceptual model of DRM was modified from previous studies. Using a modified Delphi technique, a panel of physicians (n = 19) estimated the probabilities of DRM, preventable DRM, and clinical outcomes of DRM separately for outpatients and inpatients. DRM included new medical problems (adverse drug reactions, drug dependence, and intoxications by overdose) and therapeutic failure (insufficient effects of medicines, and morbidity due to untreated indication). A COI analysis included the direct costs of DRM.
  
  
  RESULTS
  Physicians estimated that 51 ± 22% [mean ± standard deviation (SD)] of outpatients experience DRM and 12 ± 8% preventable DRM. Of inpatients, 54 ± 17% was estimated to experience DRM and 16 ± 7% preventable DRM. Of outpatients with DRM, 24 ± 11% was estimated to experience preventable DRM, whereas this proportion for inpatients was 31 ± 15%. The estimated COI was 376 euros per outpatient and 838 euros per inpatient.
  
  
  CONCLUSIONS
  Swedish physicians estimated that every other outpatient and inpatient experiences DRM, which is often preventable and costly. As physicians' estimates on the proportion of patients with DRM were higher than in observational studies in restricted subpopulations, DRM may be more common in the general population than observational studies suggest.
authors.affiliation: Nordic School of Public Health NHV, Box 12133, 40242 Gothenburg, Sweden. katja.hakkarainen@nhv.se
authors.forename: Katja M
authors.initials: KM
authors.lastname: Hakkarainen
authors.forename: Daniel
authors.initials: D
authors.lastname: Alström
authors.forename: Staffan
authors.initials: S
authors.lastname: Hägg
authors.forename: Anders
authors.initials: A
authors.lastname: Carlsten
authors.forename: Hanna
authors.initials: H
authors.lastname: Gyllensten
mesh_terms: D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D003663:Decision Trees; D003697:Delphi Technique; D004358:Drug Therapy / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008508:Medication Errors / Q000009:adverse effects* / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D015233:Models, Statistical; D010045:Outpatients / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D063487:Prescription Drug Misuse; D013548:Sweden; D017211:Treatment Failure