Prospective economic evaluation of an electronic discharge communication tool: analysis of a randomised controlled trial

Abstract

ObjectiveTo complete an economic evaluation within a randomised controlled trial (RCT) comparing the use of an electronic discharge communication tool (eDCT) compared with usual care.SettingPatients being discharged from a single tertiary care centre’s internal medicine Medical Teaching Units.ParticipantsBetween January 2012 and December 2013, 1399 patients were randomised to a discharge mechanism. Forty-five patients were excluded from the economic evaluation as they did not have data for the index hospitalisation cost; 1354 patients contributed to the economic evaluation.InterventioneDCT generated at discharge containing structured content on reason for admission, details of the hospital stay, treatments received and follow-up care required. The control group was discharged via traditional dictation methods.Primary and secondary outcome measuresThe primary economic outcome was the cost per quality-adjusted life year (QALY) gained. Secondary outcomes included the cost per death avoided and the cost per readmission avoided.ResultsThe average transcription cost was $C22.28 per patient, whereas the estimated cost of the eDCT was $C13.33 per patient. The cost per QALY gained was $C239 933 in the eDCT arm compared with usual care due to the very small gains in effectiveness and approximately $C800difference in resource utilisation costs. The bootstrap analyses resulted in eDCT being more effective and more costly in 29.2% of samples, less costly and more effective in 29.2% of samples, less effective and more costly in 23.9% of samples and finally, less costly and less effective in 17.7% of samples.ConclusionsThe eDCT reduced per patient costs of the generation of discharge summaries. The bootstrap estimates demonstrate considerable uncertainty supporting the finding of neutrality reported in the clinical component of the RCT. The immediate transcription cost savings and previously documented provider and patient satisfaction may increase the impetus for organisations to invest in such systems, provided they have a foundation of eHealth infrastructure and readiness.Trial registration number NCT01402609.

Estimated Costs of Drug-Related Problems Prevented by Pharmacist Prescription Reviews Among Hospitalized Internal Medicine Patients

“…One US study evaluated the cost and consequences of a comprehensive pharmaceutical intervention compared with usual care, where the intervention comprised a medication review and patient interview before discharge and follow-up for polypharmacy patients. The study revealed that the costs of additional time used on medication reviews, patient interviews, and follow-ups were outweighed by a decrease in costs of readmissions 14. Additional studies were conducted in the United States, Canada, Europe, and Japan, which may not be generalizable in other countries.…”

“…8,9 Numerous studies have demonstrated that pharmacist prescription reviews (PPRs) focused on identifying DRPs improve drug efficacy, prevent patient harm, reduce mortality or hospital readmissions, and contribute to cost savings and cost avoidance. [9][10][11][12][13][14] However, most studies are focused on the clinical impact of pharmacists' interventions. Only a few studies have demonstrated the economic effects of pharmacist-led prescription reviews, with the benefit-cost ratios ranging from 1.94 to 33.3.…”

“…The study revealed that the costs of additional time used on medication reviews, patient interviews, and follow-ups were outweighed by a decrease in costs of readmissions. 14 Additional studies were conducted in the United States, Canada, Europe, and Japan, which may not be generalizable in other countries. Because of the late start of clinical pharmacy service in China, most hospital pharmacies currently do not provide PPR services to hospitalized patients.…”

“…Pharmacists, with unique training in pharmacotherapy and skills in understanding the logistics of medication use processes, play a critical role in maximizing patient safety and optimizing treatment outcomes 8,9. Numerous studies have demonstrated that pharmacist prescription reviews (PPRs) focused on identifying DRPs improve drug efficacy, prevent patient harm, reduce mortality or hospital readmissions, and contribute to cost savings and cost avoidance 9-14. However, most studies are focused on the clinical impact of pharmacists' interventions.…”