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Economic analysis of the prevalence and clinical and economic burden of medication error in England
  1. Rachel Ann Elliott1,
  2. Elizabeth Camacho1,
  3. Dina Jankovic2,
  4. Mark J Sculpher2,
  5. Rita Faria3
  1. 1Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
  2. 2Centre for Health Economics, University of York, York, North Yorkshire, UK
  3. 3University of York, Centre for Health Economics, York, UK
  1. Correspondence to Professor Rachel Ann Elliott, Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK; rachel.a.elliott{at}


Objectives To provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England.

Methods We used UK-based prevalence of medication errors (in prescribing, dispensing, administration and monitoring) in primary care, secondary care and care home settings, and associated healthcare resource use, to estimate annual number and burden of errors to the NHS. Burden (healthcare resource use and deaths) was estimated from harm associated with avoidable adverse drug events (ADEs).

Results We estimated that 237 million medication errors occur at some point in the medication process in England annually, 38.4% occurring in primary care; 72% have little/no potential for harm and 66 million are potentially clinically significant. Prescribing in primary care accounts for 34% of all potentially clinically significant errors. Definitely avoidable ADEs are estimated to cost the NHS £98 462 582 per year, consuming 181 626 bed-days, and causing/contributing to 1708 deaths. This comprises primary care ADEs leading to hospital admission (£83.7 million; causing 627 deaths), and secondary care ADEs leading to longer hospital stay (£14.8 million; causing or contributing to 1081 deaths).

Conclusions Ubiquitous medicines use in health care leads unsurprisingly to high numbers of medication errors, although most are not clinically important. There is significant uncertainty around estimates due to the assumption that avoidable ADEs correspond to medication errors, data quality, and lack of data around longer-term impacts of errors. Data linkage between errors and patient outcomes is essential to progress understanding in this area.

  • medication safety
  • medical error, measurement/epidemiology
  • adverse events, epidemiology and detection
  • human error
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  • Contributors RAE, EC, DJ, MJS and RF designed, conducted and drafted the economic analysis. RAE, DJ, MJS, and RF led on the analysis on the prevalence of medication error. RAE and EC led on the analysis on the economic burden of medication error. All authors reviewed and approved the final manuscript. All authors had full access to data and take responsibility for its integrity and the accuracy of the analysis.

  • Funding This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme and conducted through the Policy Research Unit in Economic Methods of Evaluation in Health and Social Care Interventions (EEPRU), ref. 104/0001. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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