Economic and social burden of drug intoxications in Morocco: prognostic analysis of 1,787 cases and development of a medico-economic model

Abstract

Introduction: Drug intoxications lead to healthcare utilization and economic consequences that extend beyond hospital expenditure alone. In Morocco, national toxicovigilance data make it possible to identify profiles associated with prognosis and resource mobilization, but their economic burden remains poorly documented.

Objective: To identify the determinants of vital prognosis and length of hospital stay, then to develop a parameterized Moroccan model of the economic and social burden integrating direct costs, productivity losses, premature mortality, justice/social services, and quality of life.

Methods: Retrospective analytical study of 1,787 cases reported to the Poison Control and Pharmacovigilance Center of Morocco (CAPM) between 1980 and 2008. The epidemiological analysis focused on logistic regression of death, description of time to hospital discharge using Kaplan-Meier analysis, and the ROC curve of the prognostic model. A targeted literature synthesis, limited to PubMed and to publications from 2017–2024, searched for parameters on direct costs, resource utilization, productivity, premature mortality, justice/social services, and quality of life/QALY. The economic model follows a bottom-up approach based on the principle of quantity × Moroccan unit cost. It aims at a contemporary and parameterizable valuation, not a reconstruction of historical expenditures from 1980–2008.

Results: Sixteen deaths were observed (case fatality rate 0.90%). In the multivariable analysis on complete cases (n=1,493; 14 deaths), cannabis-based products were associated with lower odds of death than other substances (aOR=0.16; 95%CI 0.04–0.61; p=0.007). The apparent discrimination of the model was moderate (AUC=0.724; 95%CI bootstrap 0.595–0.841). Among the 51 cases with recorded length of hospital stay, the median was 2 days and the mean was 13.8 days, reflecting a strongly skewed distribution of resource consumption. The PubMed synthesis made it possible to structure a societal cost model distinguishing care, non-medical costs, productivity, premature mortality, justice/social services, and quality of life. As an illustration, applying a published Moroccan direct cost of 157 USD per episode corresponds to 280,559 USD for 1,787 episodes; this amount does not constitute a measure of expenditures actually incurred by the historical cohort.

Conclusion: Toxicovigilance data make it possible to identify clinical markers useful for resource stratification and for building a medico-economic model. The proposed framework is transparent and updatable, but a complete national estimate will require prospective data on unit costs, professional activity, household expenditure, judicial events, and quality of life.

Keywords: drug intoxication; economic burden; cost of illness; societal costs; toxicovigilance; logistic regression; Morocco; PubMed.

Received Date: November 05, 2024

Accepted Date: November 26, 2024

Published Date: December 01, 2024

Available Online at: https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/830