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Incidence and Cost Estimate of Treating Paediatric Adverse Drug Reactions in Lagos, Nigeria

Incidence and Cost Estimate of Treating Paediatric Adverse Drug Reactions in Lagos, Nigeria. Dr. Kazeem Adeola Oshikoya, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria. Introduction. ADRs occur frequently and globally

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Incidence and Cost Estimate of Treating Paediatric Adverse Drug Reactions in Lagos, Nigeria

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  1. Incidence and Cost Estimate of Treating Paediatric Adverse Drug Reactions in Lagos, Nigeria Dr. Kazeem Adeola Oshikoya, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria

  2. Introduction • ADRs occur frequently and globally • It accounts for a significant number of fatalities each year. • It may cause prolonged hospital admissions with a staggering cost of treatment. • The study aimed to determine the incidence of paediatric ADRs and the estimated cost of treatment over an 18-month period

  3. Methods • A prospective observational study of children admitted to the paediatric wards of the LASUTH in Nigeria, between July 2006 and December 2007. • A team of paediatric clinical pharmacologist, paediatricians, and two hospital pharmacists assessed all admissions to the paediatric wards to determine whether patients were admitted as a result of a suspected ADR or whether an ADR had occurred during admission.

  4. ADRs were defined according to Edwards and Aronson (2000). • They were identified on the basis that they were well recognized as shown by their inclusion in the summary of product characteristics, the Nigerian National Drug Formulary and the paediatric British National Formulary, or in previously published case reports. • Severity was classified according to the method of Schirm et al. (2004) • Avoidability was based on Schumock and Thornton (1992) Criteria

  5. Table 1. Baseline demographics of the mothers and costing data for the hospital Parameters Moderate (n = 21) Severe (n = 14) P-value Mothers’ demographics Mean age (years) 36.5 ± 6.8 years 37.2 ± 5.5 years 0.873 Levels of education None 3 2 0.527 Primary 7 4 0.865 Secondary 8 6 0.804 University/polytechnic /college 3 2 0.527 Mean annual household income 10,825.00 186,608.00 0.693 ± 15,225.70 ± 32,318.44 Hospital costs Inpatient cost per bed day 200.00 200.00 - Pediatrician consultation fee 214.30 214.30 - Specialist consultation fee 214.30 214.30 - Nursing care fee - - - Social worker fee 100.00 100.00 - Psychologists fee 100.00 100.00 - Other cost per day - - -

  6. Results • 2,400 children were admitted during the study; 12 (0.6%) were admitted because of ADRs and 23 (1.2%) developed ADR(s) during admission. • 40 ADRs (severe: 23 cases, moderate: 15 cases, and fatal: 2 cases) were suspected in 35 patients and involved 53 medicines. • An average of 4.2 to 4.5 medicines were used per patient with ADRs. • Self-medication contributed to 7 cases of admission because of ADRs.

  7. Antibiotics (50%) were the most suspected medicines. • 33 ADRs were Type A • 7 ADRs were idiosyncratic • 8 ADRs were judged to be avoidable • Approximately 1.83 million naira (USD 15, 466:60) was expended to manage all the patients admitted due to ADRs.

  8. Table3: Clinical details and characteristics of patients admitted due to adverse drug reactions and the suspected medicines (ADR)

  9. Table 4: Clinical details and characteristics of inpatients who experienced adverse drug reactions (ADR) and the suspected medicines

  10. Table 4. Mean cost to the hospital per single adverse drug reaction (ADR) admission in 2007 naira Direct medical costs to hospital Moderate(n = 5) Severe (n = 7) P-value Days of hospitalization 10.4 ± 2.1 days 15.7 ± 7.4 days < 0.001 Hospitalization costs 2,080.00 ± 420.00 3,140.00 ± 680.00 0.043 Healthcare professional fees 4,308.72 ± 870.03 13,233.53 ± 3,625.00 < 0.001 Medication costs 3,400.00 ± 240.00 36,800.00 ± 7,200.00 < 0.001 Diagnostic costs 3,300.00 ± 232.10 10,750.00 ± 2,788.00 < 0.001 Others 600.00 ± 59.20 1,800.00 ± 498.00 < 0.001 13,688.72 65,723.53 ± 1,821.33 ± 14,791.00 < 0.001 Follow up visit costs 1,628.60 ± 61.28 6,170.00 ± 1,729.10 < 0.001 Total cost per ADR case: Naira 15,317.32 ± 1,882.6171,893.53 ± 16,520.10 < 0.001 USD (1 USD = 118)129.81 ± 15.95 609.27 ± 140.00

  11. Conclusion • Treating paediatric ADRs was substantially expensive. • Paediatric drug use policy in Nigeria needs to be reviewed to discourage self-medication, polypharmacy prescribing, and sales of prescription medicines without prescription.

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