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Costs of Intravenous Adverse Drug Events in Academic and Nonacademic Intensive Care Units

Nuckols, Teryl K. MD, MSHS*†; Paddock, Susan M. PhD*; Bower, Anthony G. PhD; Rothschild, Jeffrey M. MD, MPH§; Fairbanks, Rollin J. MD, MS; Carlson, Beverly MS, RN, CNS; Panzer, Robert J. MD; Hilborne, Lee H. MD, MPH***

doi: 10.1097/MLR.0b013e3181589bed
Original Article

Background: Adverse drug events (ADEs), particularly those involving intravenous medications (IV-ADEs), are common among intensive care unit (ICU) patients and may increase hospitalization costs. Precise cost estimates have not been reported for academic ICUs, and no studies have included nonacademic ICUs.

Objectives: To estimate increases in costs and length of stay after IV-ADEs at an academic and a nonacademic hospital.

Research Design: This study reviewed medical records to identify IV-ADEs, and then, using a nested case-control design with propensity-score matching, assessed differences in costs and length of stay between cases and controls.

Subjects: A total of 4604 adult ICU patients in 3 ICUs at an academic hospital and 2 ICUs at a nonacademic hospital in 2003 and 2004.

Measures: Increased cost and length of stay associated with IV-ADEs.

Results: Three hundred ninety-seven IV-ADEs were identified: 79% temporary physical injuries, 0% permanent physical injuries, 20% interventions to sustain life, and 2% in-hospital deaths. In the academic ICUs, patients with IV-ADEs had $6647 greater costs (P < 0.0001) and 4.8-day longer stays (P = 0.0003) compared with controls. In the nonacademic ICUs, IV-ADEs were not associated with greater costs ($188, P = 0.4236) or lengths of stay (−0.3 days, P = 0.8016). Cost and length-of-stay differences between the hospitals were statistically significant (P = 0.0012). However, there were no differences in IV-ADE severity or preventability, and the characteristics of patients experiencing IV-ADEs differed only modestly.

Conclusions: IV-ADEs substantially increased hospitalization costs and length of stay in ICUs at an academic hospital but not at a nonacademic hospital, likely because of differences in practices after IV-ADEs occurred.

From the *The RAND Corporation, Santa Monica, California; †Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles; Los Angeles, California; ‡Amgen, Inc., Thousand Oaks, California; §Brigham and Women’s Hospital, Boston, Massachusetts; ¶University of Rochester, Rochester, New York; ∥Sharp HealthCare, San Diego, California; and **Department of Pathology and Laboratory Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, California.

Supported by Cardinal Health (formerly Alaris Medical Systems), San Diego, CA.

Anthony G. Bower, PhD, was formerly at The RAND Corporation, Santa Monica, California.

Reprints: Teryl Nuckols, RAND Corporation, 1776 Main Street, Box 2138, Santa Monica, CA 90407-2138. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.