title: National burden of preventable adverse drug events associated with inpatient injectable medications: healthcare and medical professional liability costs.
abstract: BACKGROUND
  Harmful medication errors, or preventable adverse drug events (ADEs), are a prominent quality and cost issue in healthcare. Injectable medications are important therapeutic agents, but they are associated with a greater potential for serious harm than oral medications. The national burden of preventable ADEs associated with inpatient injectable medications and the associated medical professional liability (MPL) costs have not been previously described in the literature.
  
  
  OBJECTIVE
  To quantify the economic burden of preventable ADEs related to inpatient injectable medications in the United States.
  
  
  METHODS
  Medical error data (MedMarx 2009-2011) were utilized to derive the distribution of errors by injectable medication types. Hospital data (Premier 2010-2011) identified the numbers and the types of injections per hospitalization. US payer claims (2009-2010 MarketScan Commercial and Medicare 5% Sample) were used to calculate the incremental cost of ADEs by payer and by diagnosis-related group (DRG). The incremental cost of ADEs was defined as inclusive of the time of inpatient admission and the following 4 months. Actuarial calculations, assumptions based on published literature, and DRG proportions from 17 state discharge databases were used to derive the probability of preventable ADEs per hospitalization and their annual costs. MPL costs were assessed from state- and national-level industry reports, premium rates, and from closed claims databases between 1990 and 2011. The 2010 American Hospital Association database was used for hospital-level statistics. All costs were adjusted to 2013 dollars.
  
  
  RESULTS
  Based on this medication-level analysis of reported harmful errors and the frequency of inpatient administrations with actuarial projections, we estimate that preventable ADEs associated with injectable medications impact 1.2 million hospitalizations annually. Using a matched cohort analysis of healthcare claims as a basis for evaluating incremental costs, we estimate that inpatient preventable ADEs associated with injectable medications increase the annual US payer costs by $2.7 billion to $5.1 billion, averaging $600,000 in extra costs per hospital. Across categories of injectable drugs, insulin had the highest risk per administration for a preventable ADE, although errors in the higher-volume categories of anti-infective, narcotic/analgesic, anticoagulant/thrombolytic and anxiolytic/sedative injectable medications harmed more patients. Our analysis of liability claims estimates that MPL associated with injectable medications totals $300 million to $610 million annually, with an average cost of $72,000 per US hospital.
  
  
  CONCLUSIONS
  The incremental healthcare and MPL costs of preventable ADEs resulting from inpatient injectable medications are substantial. The data in this study strongly support the clinical and business cases of investing in efforts to prevent errors related to injectable medications.
authors.affiliation: Vice President, Health Economics and Outcomes Research, Becton, Dickinson and Company, Franklin Lakes, NJ.
authors.forename: Betsy J
authors.initials: BJ
authors.lastname: Lahue
authors.affiliation: Principal, Consulting Actuary, Milliman Inc, New York, NY.
authors.forename: Bruce
authors.initials: B
authors.lastname: Pyenson
authors.affiliation: Consulting Actuary, Milliman Inc, New York, NY.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Iwasaki
authors.affiliation: Principal, Senior Health Consultant, Milliman Inc, New York, NY.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Blumen
authors.affiliation: Consulting Actuary at Milliman Inc, New York, NY.
authors.forename: Susan
authors.initials: S
authors.lastname: Forray
authors.affiliation: Associate Professor of Medicine, Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild