Cost-effectiveness analysis of a hospital electronic medication management system

Abstract

Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS).Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs.Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially.Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.

Systematic review of predictive risk models for adverse drug events in hospitalized patients

“…Traditional efforts to reduce inpatient ADEs have focused primarily on systems measures . Implementation of electronic medication management systems, including electronic prescribing and automated dispensing, have been shown to significantly reduce medication errors and a number of Australian hospitals are adopting these systems in accordance with the government's E‐Health strategy . However, such systems are expensive and, if not well implemented and maintained, can introduce new errors with potential for ADEs .…”

Validation of a score to identify inpatients at risk of a drug-related problem during a 4-year period

“…Several strategies have been associated with an increase in medication safety, such as the implementation of electronic prescription and some integrated clinical decision support systems. These have been associated with a decrease in the risk of medication errors and adverse drug events (Ammenwerth et al, 2008, Prgomet et al, 2017, Radley et al, 2013, Reckmann et al, 2009, Westbrook et al, 2015), as well as cost reductions (Ahmed et al, 2016, Eslami et al, 2008, Kaushal et al, 2006, Westbrook et al, 2015).…”

Why is measuring the effects of information technology on medication errors so difficult?

“…Technology targeted to the problem of medication errors in hospitals is potentially transformative in reducing adverse drug events, increasing appropriate and effective prescribing and administration of medications, and reducing health-care costs. 2,3 Electronic prescribing systems (also known as computerised provider order entry systems) have been associated with substantial reductions in medication errors, but important questions remain regarding their effects and the mechanisms that contribute to these effects over time. These are adaptive sociotechnical implementations, often involving numerous people.…”