Evidence Table 8bSummary of partial economic evaluation studies

Author (year)
Country
Type of economic evaluationStudy objectiveStudy design (include setting)Population (n)Currency (year)

Cost elements
Effect measureIntervention and alternative being evaluatedMain economic findings
Chertow (2001)18
U.S.
Cost- analysisTo determine if a system application for adjusting drug dose and frequency in patients with renal insufficiency, when merged with a computerized order entry system, improves drug prescribing and patient outcomesFour consecutive 2-month intervals consisting of control (usual computerized order entry) alternating with intervention (computerized order entry plus decision support system) conducted in September 1997– April 1998 at a 720-bed urban tertiary care teaching hospital.Hospitalized patients with renal insufficiency, 7,887 admissions during the 2 intervention periods (2 months each) 9,941 admissions in the 2 control periods (2 months each)?? assumed 1997/1998

Hospital and pharmacy charges
Rates of appropriate prescription by dose and frequency, length of stay, and changes in renal function, compared among patients with renal insufficiencyReal-time computerized decision support system for prescribing drugs in patients with renal insufficiency. During intervention periods, the adjusted dose list, default dose amount, and default frequency were displayed to the order-entry user and a notation was provided that adjustments had been made based on renal insufficiency. During control periods, these recommended adjustments were not revealed to the order- entry user, and the unadjusted parameters were displayed.There were no significant differences in estimated hospital and pharmacy costs. USD$4,881 vs. USD$4,968 in total costs and USD$168 vs. USD$166 for the intervention and the control groups, respectively LOS was shorter for the intervention group 4.3 days vs. 4.5 days, p = 0.009 even after adjusting for sex, age and DRG there remained a significant difference p = 0.002.
Barenfanger (2001)287
U.S.
Cost- analysisTo assess the impact of improved interventions facilitated by
  1. a computer software program which electronically notifies pharmacists of potential problems with a patient’s antimicrobial therapy, and
  2. the education of pharmacists making interventions and notification of the medical staff of the program.
Quasi RCT (2 arm) of hospitalized patients prospective study in a 450-bed community teaching hospital over a 5 month time periodPatients:
  1. infected with a bacterial isolate with no order for antimicrobial therapy,
  2. infected with bacteria resistant to current antimicrobial therapy,
  3. on therapy not tested, and
  4. on antimicrobial therapy but from whom no sample for culture had been taken.
Analysis A: 24 patients in control group, 52 patients study group; Analysis B&C: (DRG) matched samples study group: 188, control group: 190
?? assumed 1998/1999

Total costs, fixed costs (overhead) variable direct (pharmacy costs, supplies, lab tests, radiology tests) fixed indirect costs
Mortality, length of stayCompared patients whose microbiologic data were processed in the normal manual manner in the pharmacy to patients whose microbiological data were processed using the computer software, TheraTrac 2, a computer software program which electronically links susceptibility testing results immediately to the pharmacy and alerts pharmacists of potential interventionsAnalysis A: study group had average total standard cost of $21,189 per patient; control group had average total standard cost of $51,790 per patient, a decrease of $30,601 per patient in study group (p = 0.41) Analysis B (DRG- matched patients for whom susceptibility testing was done): study group had average total standard cost of $13,294 per patient; control group had average total standard cost of $18,601 per patient, a decrease of $5,308 per patient in study group (p = 0.008). Analysis C:(severity adjustment) study group had average total standard cost of $13,294 per patient; severity- adjusted control group had average total standard cost of $16,106 per patient, a decrease of $2,812 per patient in study group (no statistical analyses performed)
By using these severity- adjusted data (that the data management team relies on), estimated variable cost savings annually from the improvement of interventions is $2,932,000 (2,000 in patients for whom susceptibility testing is done X $1,466). If the list price of TheraTrac 2 ($44,500) is subtracted from the expected annual cost savings from the use of our program to improve interventions ($2,932,000), the resulting savings ($2,887,500) is still substantial in the first year. The present study demonstrates the financial benefits of improved interventions involving antimicrobial agents, namely, statistically significant differences in lengths of stay, total costs, variable costs, and radiology costs.
Chisolm (2006)19
U.S.
Cost analysisTo assess the relationship between use of a computerized order set within a CPOE and processes of care pediatric asthma treatmentBefore/after. ‘Pre- set’ patients: those admitted prior to order set implementation; ‘no set’: those admitted after implementation when asthma order set not used; ‘set’ patients admitted after implementation and the order set was used. Inpatient pediatric teaching hospitalAsthma patients between the age of 2 and 20 years admitted to hospital between November 2001 and November 2003 (excluded those admitted to ICU). N=790 (261 ‘pre– set’; 63 ‘no set’; 466 ‘set’ cases)USD (year not stated)

Length of stay, total inpatient charges and pharmacy charges
Use of systemic corticesteroids, use of pulse oximetry, and use of metered- dose inhalers.Computerized order set within a CPOE system before and after implementation of the asthma order setNo significant difference in costs or lengths of stay among the three groups. Total charges were $3,620, $3,567, $3,759; pharmacy charges were $416, $373, $429; and LOS was 1.94, 1.93 and 1.77 for the ‘no set’, ‘pre-set’, and ‘set’ groups respectively.
Cobos (2005)23
Spain
cost analysisTo assess the cost and effectiveness of a CDSS based on recommendations of the ESCHM in comparison with usual care for patients with hypercholesterolaemiaA multi-centre cluster- randomized, unblinded, pragmatic trial. (Primary care) Perspective not stated (1 year time horizon)Patients with hypercholesterolaemia, which was defined as total cholesterol concentrations >200 mg/dL. Patients were excluded if they had triglyceride concentrations >400 mg/dL or were participating in another study. 44 practices, 2,221 patients (1,161 usual care, 1,060 CDSS)Euros (2002)

Direct costs only: physician visits, lab analyses, lipid-lowering drugs
Achievement of LDL-C reduction goals in patients with CVR of >20% over 10 yrs or keeping it <20% when patient baseline was <20%CDSS vs. usual careThe treatment costs were €214,683 in the usual care group and €125,569 in the intervention group. The total costs were €264,658 in the usual care group and €170,061 in the intervention group. The adjusted means of the treatment costs per patient were €237 in the usual care group and €178 in the intervention group. The difference was €59 (95% CI: €34 to €83; p <0.0001). The adjusted means of the total costs per patient were €283 in the usual care group and €223 in the intervention group. The difference was €60 (95% CI: €33 to €86; p = 0.001). The CDSS did not alter the effectiveness of usual care but induced considerable savings.
Evans (1992)283
U.S.
quasi cost analysisTo use a hospital information system to help identify ADEs and to create a database of ADEs to prevent specific types of ADEPre-post design using a computerized ADE surveillance system vs. a control group with no ADEsHospital-ized patientsUSD (not stated)

Hospitalization costs
Reduction in ADEs and LOSComputerized surveillance with physician notification only of verified ADEs if classified as server or life- threatening vs. physician immediately notified of all ADEs when they were verified. Either the clinical pharmacist of ADE study nurse contacted the prescribing physician and recommended a change in drug or dosage vs. a control populatin of patients who received drugs but did not have ADEsThe average cost of hospitalization was $38,007 for patients with severe ADEs compared to $22,474 (p <0.002) for patients with moderate ADEs and $6,320 for patients without ADEs.
Evans (1998)35
U.S.
Cost analysisTo evaluate a CDSS to improve the use of and reduce the cost of antibioticsProspective study in a 12 bed Shock/Trauma/Re spiratory ICU. (before/after) 12 months398 patients in intervention (divided into those who got the recommended treatment and those who did not); 766 patients in control. # of physicians not statedUSD (1995)

Cost of antibiotics and cost of hospitalization
# of ADEs, # of days of excessive antibiotic dosage, LOS, and mortalityAntibiotics ordered using CDSS by physicians during the study period compared to the control periodThe cost of anti-infective agents was $102 vs. $340 and $427 (p <0.001) and the total cost of hospitalization was $26,315 vs. $35,283 and $44,865, (p <0.001). for and regimen overridden, respectively. control, regimen followed,
Evans (1999)214
U.S.
Cost analysisTo examine the effect of a computer- assisted antibiotic dose monitor used to reduce the number of days that patients receive excessive dosages of antibiotics and the number of ADEs secondary to antibiotics.Descriptive epidemiologic study of a two- year preintervention period and one- year intervention period. 12 month intervention periodAll patients ≥18 years, admitted to Hospital from April 1 1993 to March 31 1996, who received ≥1 of 5 targeted antibiotics who had a serum creatinine or a urine creatinine clearance test result before antibiotic therapy, and who were never admitted or transferred to the ICU. # of physicians not statedUSD (1996)

Cost of antibiotics
# of ADEs, # of days of excessive antibiotic dosageAntibiotics ordered using CDSS by physicians during the study period compared to the control periodThe intervention group had a lower and at a lower mean cost ($80.62 vs. $92.96; p <0.02) of antibiotics than patients during the preintervention period.
Evans (1994)37
U.S.
Cost analysisTo evaluate a CDSS to assist physicians in the selection of appropriate empiric antibioticsTwo-stage random-selection study (tertiary, private hospital and major teaching centre associated with a university). 12 month time frame28 physicians, 482 culturesUSD (1994)

Cost of antibiotics
Computer- suggested antibiotics with results of susceptibility tests of cultures and antibiotics selected by physicianAntibiotics ordered using CDSS by randomized physicians were then compared between crossover periods of antibiotic consultant use.The average cost for 24 hours of therapy for the computer-suggested antibiotics was $41.08 per patient, compared with an average of $51.93 (p <0.001) for the antibiotics actually prescribed by physicians.
Evans (1995)284
U.S.
Cost analysisTo evaluate a CDSS to improve the use of and reduce the cost of antibioticsA 7-month pilot was compared with 12-months previous in a 12- bed Shock/Trauma/Respiratory ICU. 7 months588 orders for antibiotics, # of physicians not statedUSD (1994)

Cost of antibiotics
# of ADEs and LOSAntibiotics ordered using CDSS by physicians during the study period compared to the control periodThe mean cost of antibiotics was $87.03 (p <0. 04) less per patient during the study period as compared to the control period.
Javitt (2005)218
U.S.
Cost analysisTo demonstrate the potential effect of deploying a sentinel system that scans administrative claims information and clinical data to detect and mitigate errors in care and deviations from best medical practicesRCT, members of an HMO were randomly assigned to an intervention or a control group. Care considerations (CC) generated by the CDSS for subjects in the intervention group were relayed to treating physicians, and those for the control group were deferred to study end.Intervention and control group members consisted of all health plan enrollees who were between the ages of 12 and 64 years and had incurred at least 1 physician claim or 1 pharmacy claim in the 12 months before enrollmentUSD (not specified)

Total charges, in- patient charges; out-patient charges; Rx charges; professional charges
CCs generated by group; physician compliance with recommendation; and hospital utilizationCDSS tool that produces an electronic record from administrative data and runs it through a set of decision rules identifies “issues” and sends a CC message to the physician in the intervention group but nothing sent to the control group until the end of the study.Charges for those whose recommendations were communicated were $77.91 per member per month (pmpm) lower and paid claims were $68.08 pmpm lower than controls compared with the baseline (p = 0.003 for both). Paid claims for the entire intervention group (with or without recommendations) were $8.07 pmpm lower than those for the entire control group. In contrast, the intervention cost $1.00 pmpm, suggesting an 8- fold return on investment.
Javitt (2008)74
U.S.
Cost analysisTo determine whether a CDSS tool improves quality of care and the effect of the intervention on average charges per member per month.RCT, participants randomized to study group had the software turned on. Software was not turned on for patients in the control group until the 1-year experiment was over. Conducted in a large HMOPatients all had medical charges in the previous year, all patients <65 yrs n = 19,719 intervention group, n = 19,792 control groupUSD (2001)

Total charges, in- patient charges; out-patient charges; Rx charges; professional charges
Rate at which CC are resolvedCDSS tool that produces an electronic record from billing records, lab feeds and pharmacies then runs the record through a set of decision rules, identifies “issues” and sends a CC message, 3 levels of CCs; level 1 contains potentially life- threatening situations, level 2 might have an important effect on clinical outcomes, level 3 are preventative care issues. All CCs reviewed by doctors employed by software company. HMOs medical director received level 1 messages and called the appropriate physician. Level 2 and 3 were received by an HMO nurse who then decided whether to send message to physician. Data collected in control group but CCs turned off.The intervention reduced the average of total charges in the study group by 6.1%; average charge for the control group ($327.54 vs. $352.31 pmpm)
Kaushal (2006)286
U.S.
Cost analysisTo assess the costs and benefits associated with the implementation of a CPOE and CDSS system over 10 years (1993–2002)Cost and benefit estimates of a hospital CPOE system in a 720- adult bed, tertiary care academic hospital. With 7% discountingPatients admitted to the hospital over the 10 year timeframeUSD (2002)

Capital and operational costs, drug costs, hospital costs
Reductions in ADEs, LOS, proportion of appropriate prescripttions, laboratory & radiology tests (some measures from the literature)CPOE with graduated CDSS over 10 years compared to estimates of what it might have been like without the CPOE$11.8 million to develop, implement, and operate CPOE; over 10 yrs, the system saved the hospital $28.5 million. It took over 5 years to realize a net benefit and over 7 years to realize an operating budget benefit.
Macdonald (2002)285
Canada
Cost analysisEvaluation of the safety and potential cost savings of a computerized, laboratory- based program to manage inpatient warfarin thromboprophylaxis after major joint arthroplasty.A consecutive- case study of adults admitted over a 54-month period (July 1994–December 1998) in a tertiary care orthopedic institution compared with Patients who underwent similar procedures in the 18-month period before the program was introduced (<1994) served as historical controls. These patients received the identical loading doses of warfarin and were individually managed by staff surgeons or internists.Patients requiring joint arthroplasty who had no recent episodes of thromboembolic disease, no mechanical heart valve, atrial fibrillation, severe liver disease or baseline inter-national normalized ratio [INR] greater than 1.3 (n = 4,729, intervention vs. n = 279, control)CAD (year not stated)

Pharmacy and comparative nursing care costs associated with the program
Test results maintained within the desired therapeutic range (INR 2.0–3.0), clinically severe bleeding episodes, readmission rates, clinically symptomatic and venographically proven episodes of venous thrombosis or pulmonary embolismMajor joint arthroplasty with warfarin therapy administered through the computerized program compared with an historical control group Patients who underwent similar procedures in the 18-month period before the program was introduced served as historical controls. These patients received the identical loading doses of warfarin and were individually managed by staff surgeons or internists.The potential savings per patient would be 11 minutes of nursing time or $5.50/patient daily for a total annual figure, based on 10,152 patient days per yr of $55,836.
NOTE: The cost estimates and potential cost savings are speculative and are meant to be illustrative and not conclusive in nature.
McGregor (2006)104
U.S.
Cost-analysisTo evaluate the effectiveness and cost effectiveness of a web-based, computerized CDSS for the management of antimicrobial utilizationRCT (2 arm), in- patients a 648- bed tertiary care, academic hospital over a 3 month periodn = 4,507 (n = 2,237 intervention arm & n = 2,270 control)USD (2004)

Hospital antimicrobial costs (primary outcome)
Mortality, LOS, frequency of tests for C. difficile, time spent managing antimicrobial utilizationAntimicrobial utilization was managed by an existing antimicrobial management team (AMT) using the system in the intervention arm and without the system in the control arm. The system was developed to alert the AMT of potentially inadequate antimicrobial therapy. This is a “back- end” or post-prescription review.Hospital antimicrobial expenditures were $285,812 for intervention vs. $370,006 in the control arm, for a savings of $84,194 (23%), or $37.64 per patient
McMullin (2004)281
U.S.
Cost analysisTo evaluate the impact on prescription costs of a computerized decision support system (CDSS)Retrospective cohort study (before-after) using pharmacy claims database in primary care. Clinicians using CDSS were matched to controls with 6 month followup19 physicians in each groupUSD (not stated)

New prescription costs
NILCDSS that provides evidence-based recommendations to clinicians during the electronic prescribing process before and after implementationAverage cost for intervention group per new prescription $4.16 lower (p = 0.02); for new and refilled prescriptions $4.99 lower (p = 0.01). The 6 month savings from new prescriptions and their refills were estimated to be $3,450 (95% CI, $1,030 to $5,863) per clinician.
McMullin (2005)282
U.S.
Cost analysisTo evaluate the impact on prescription costs of a computerized decision support system (CDSS)Retrospective cohort (before- after) study using pharmacy claims database in primary care. Clinicians using CDSS matched to controls. 12 months (extension of the 6-month study described above)19 physicians in each groupUSD (not stated)

New and existing prescription costs
NILCDSS that provides evidence-based recommendations to clinicians during the electronic prescribing process before and after implementationThe average cost per new prescription decreased by $1.00 (−2.4%) in the intervention group while it increased by $3.75 (9.0%) in the control group. The 12 month savings on new prescriptions were $109,897
Mekhjian (2002)186
U.S.
Cost- analysisTo evaluate the benefits of computerized physician order entry (POE) and electronic medication administration record (e-MAR) on the delivery of health careCohort of inpatient nursing units in an academic health system (3 sites Cancer hospital, state hospital, rehab centre), before-and-after POE
The study comprised before- and-after comparisons between phase 1, preimplementation of POE (pre- POE) and phase 2, postimplementation of POE (post- POE) and, within phase 2, a comparison of POE and the combination of POE plus e-MAR for a period of 10 to 12 months across all services in the respective hospitals.
Cohort of inpatient nursing unitsUSD (2002)

Total costs per patient
LOS, medication turn-around time, radiology turn-around time, laboratory test turn- around time, medication transcription errorsphase 1, preimplementation of POE (pre-POE) and phase 2, postimplementation of POE (post-POE) and, within phase 2, a comparison of POE and the combination of POE plus e-MARState hospital total costs for the heart transplant service (pre-POE, $5,264; post-POE, $4,871; p = 0.013) and organ transplant service (pre- POE, $8,382; post-POE, $7,711; p = 0.043) showed a statistically significant decrease, whereas costs for general surgery (pre- POE, $4,995; post-POE, $5,567; p = 0.008) showed a statistically significant increase. There were no statistically significant changes in other services. Cancer: services such as surgical oncology (pre- POE, $6,087; post-POE, $5,631; p = 0.008) and neurology/neurosurgery (pre-POE, $5,600; post-POE, $5,125; p = 0.045) showed statistically significant reductions in total costs, whereas the POE, $5,821; p <0.001) showed a statistically significant increase in total costs and thoracic surgery (pre=POE, $5,181; post=POE, $5,946; p = 0.055) showed a nonsignificant increase. When all the services were combined, severity adjusted total cost per admission did not change significantly in either state (pre-POE, $5,697; post- POE, $5,661; p = 0.687) or in the cancer hospital (pre- POE, $6,427; post-POE, $6,518; p = 0.502).
Mullett (2001)109
U.S.
Cost- analysisTo evaluate the impact of a pediatric anti- infective CDSS.Cohort, patients in a 26-bed pediatric intensive care unit in an academic 232-bed hospital 6-month pre- vs. postimplementationN=1758 (809 control, 949 intervention)USD (1999)

Hospital costs, anti-infective drug charges
Number of anti-infective drugs used, total doses used, LOS, mortalityCDSS vs. pre-CDSS (all patient care orders from the physicians were handwritten. Antibiotic and other medication orders typically were interpreted by the clerk and rewritten onto the bedside medication administration record. Carbon copies of the handwritten order were physically sent to the pharmacy and read by a pharmacist, who entered the order via the keyboard into the HELP system’s pharmacy module.no difference in hospital costs $28,257.67 (control) vs. $25,032.11 (intervention) no difference in mean anti- infective cost/patient $274.79 (control) vs. $289.60 (intervention)
Ornstein (1999)288
U.S.
Cost- analysisTo determine the impact of displaying prescription cost information in a computer- based patient record (CPR) system on decreasing drug costs by family physiciansDuring a 6-month period, cost information was not displayed; during the subsequent 6- month intervention period, costs were displayed at the time of prescribing. Academic family practice setting.10 physicians, 36 residentsUSD (1995/1996)

Prescription costs
NilCPR system that displays drug cost information at time of prescription order compared to no cost information being displayed during the control periodThis study failed to detect an impact of CPR-based prescription drug cost information on overall drug costs to patients among family physicians in an academic family medicine ambulatory clinical practice The mean (SD) cost per prescription in the control period was $21.83 ($27.00), and in the intervention period was $22.03 ($28.12), (p = 0.61).
The mean (SD) cost/contact control $12.49 ($29.35) vs. intervention $13.03 ($30.06) (p = 0.12).
Paul (2006)123
Israel, Germany, Italy
Cost analysisCohort study: the aim was to compare CDSS advice with physician performance for antibiotic treatment and antibiotic costs. In the RCT, the goal was to assess whether the CDSS improved physician performance and patient- related outcomesProspective cohort study comparing a CDSS for antibiotic treatment advice to physician’s treatment followed by a multicentre, cluster randomized trial comparing wards using the CDSS vs. antibiotic monitoring without the CDSS. (Cohort-6-month time period between 2002/2003 in each of the 3 countries; RCT-6- month period in 2004)
3 university affiliated primary and tertiary hospitals (Israel, Germany, Italy)
Patients suspected of harboring bacterial infections in 3 university affiliated primary and tertiary hospitals (Israel, Germany, Italy)
Cohort:1,203 patients
RCT: 2,326 patients
Euros (2002/2004)

Antibiotic costs including:
  1. direct drug & administration,
  2. ADE (rates from the literature and assigned costs in hospital days and QALYs),
  3. ecological costs (patient costs, probability of infection and antibiotic failure; costs to eco- system for loss of antibiotic efficacy, penalty cost for drugs of last resort (antibiotic costs, including costs related to future antibiotic resistance)
Appropriate antibiotic treatment, mortality, LOSCDSS recommends treatment by highlighting the 3 top-ranked antibiotic regimens, with the highest cost-benefit difference, including no antibiotic treatment wards using the CDSS vs. antibiotic monitoring without CDSS).
CDSS advises antibiotic therapy for inpatients using data available at the time of empirical antibiotic treatment.
COHORT: All cost components, except those related to expected adverse events, were significantly lower for the treatments suggested by the CDSS compared with those used by physicians. Total antibiotic costs were €289 lower per patient for CDSS compared with physicians, a relative decrease of 48%.
RCT: the use of the CDSS resulted in significantly lower antibiotic costs in intervention vs. control wards, the difference originating from lower ecological costs in intervention wards in Israel and Italy. Direct antibiotic costs, as well as costs incurred by observed adverse events, were similar-mean total antibiotic costs per patient €623.2 (control) vs. €565.4 (intervention) p = 0.007 Total projected costs for the appropriate CDSS regimens were lower than physician’s treatment by €262 per patient, a relative decrease of 44%, with the reduction originating mainly from lower ecological costs
Piontek (2010)290
U.S.
Cost analysisThe effects of an adverse- ADE alert system on cost and quality outcomes in community hospitals were evaluated.Retrospective observational study evaluated the effects of an ADE alert system in seven hospitals in a health network. Outcomes after, and one year before, the deployment of an ADE alert system were evaluated. Inpatients in two hospitals without any computerized ADE alert system constituted the control group. Administrative data were gathered for patients from these facilities for the same time frames as for the pre- implementation and post- implementation groups.All inpatients admitted to one of seven hospitals in a health networkUSD (not indicated) Primary outcomes evaluated included pharmacy department costs, variable drug costs. Secondary outcomes included total hospitalization costsPrimary outcomes included mortality rates. Secondary outcomes included LOS, rate of readmission, and case-mix indexPre-post ADE alert system. Four distinct groups were evaluated:
  1. preimplementation of the ADE alert system (internal control group),
  2. postimplementation group,
  3. external control group matching internal control time frame, and
  4. external control group matching ADE postimplementation time frame.
Statistically significant decreases were observed in average pharmacy department costs per patient ($867 vs. $826, p <0.001) from preimplementation to post –implementation. In contrast, the external control group had a significant increase in pharmacy department costs ($734 vs. $797, p = 0.029). Drug costs decreased significantly from baseline ($360 vs. $337, p <0.001) in the study group. Conversely, there were significant increases in drug costs in the external control group ($401 vs. $429, p = 0.029).
Stone (2009)158
U.S.
Cost- analysisPresentation of the implementation of a CPOE system in the management of surgical patientsRetrospective and prospective analyses of patient-safety measures 6 months pre- and 6 months post- CPOE institution, respectively. Inpatients of a multispecialty hospital academic surgical practicePaper only provides the number of surgical procedures pre and post: 6,815 procedures in the pre period and 5,963 in the first post 6 month and 6,106 in the second 6 months postimplementationUSD (2007/2008)

Personnel requirements (efficiencies) and capital costs of implementation
Patient safety, medication errors, order implementation timeCPOE compared to no CPOE
-

total capital costs for implementation $2.9 million and operating costs of $2.3 million

-

decrease in the number of unit secretaries (clarified orders and transcribed the orders to a required format);

-

savings of $445,500 (personnel changes occurred as a consequence of work-load redistribution).

Considerable gains in efficiency were noted, which included the time necessary to have orders accessible to nursing, radiology, and laboratory. This gain in efficiency will likely result in long-term cost savings and increased quality of care. Additionally, personnel needs were reduced, which subsequently resulted in additional financial benefit for our institution.
Tierney (2005)167
U.S.
Cost analysisTo assess whether guideline-based care suggestions delivered via physicians’ and pharmacists’ computer (CDSS) workstations could improve the outpatient management and outcomes among patients with asthma or COPD1-year, 2x2 factorial, 4 arm RCT, academic general internal medical practice in a hospital246 physicians and 20 outpatient pharmacists randomized (706 patients included)USD (1994–1996)

Total health care charges (Outpatient charges + inpatient charges)
Adherence to treatment guidelines, QOL, patient satisfaction with physician & pharmacists, ER visits, hospitalizations.Care recommendations provided electronically to physicians, pharmacists, both physician & pharmacist vs. no care recommendations/interventionPatients in the group receiving only the physician intervention had significantly elevated total health care charges, possibly because of just a small number of extremely high-cost hospitalizations costs
Control (n=80):$5,800 (SD: 8,536)
Physician only (n=81):$8,006 (SD: $18,720)
Pharmacist only (n=80):$5,333 (SD:$9,400)
Both physician & pharmacist (n=82):$5,652 (SD: $10,579)
Tierney (2003)166
U.S.
Cost analysisTo assess the effects of an established EMR system containing a CPOE with a guideline-based CDSS for managing patients with IHD and chronic HF1-year, 2x2 factorial, 4 arm RCT, academic, primary care group practice (targeting physicians and pharmacists)11 full time & 9 part-time outpatient pharma-cists, ?? physicians; 32 practice sessions (706 patients included)USD (1994–1996)

Total health care charges (Outpatient charges + inpatient charges)
Adherence to recommendation, health- related QOL, exacerbation of heart disease, patient satisfaction with physician and pharmacist, medication compli-ance, satisfaction with care, physician attitude toward interventionEvidence-based cardiac care recommendations displayed electronically to physicians, pharmacists, physician & pharmacists vs. no recommendations for enrolled patientsNo difference in total costs across groups Costs:
Control (n=181): $7,025 (SD $17,024)
Physician only (n=197): $6,302 (SD 10,928)
Pharmacist only (n=158); $7,387 (SD: $13,206)
Both physician and pharmacist (n=170): $7,639 (SD:$16,921)
Tierney (1993)289
U.S.
Cost analysisTo assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders (CPOE) that encourage cost effective ordering. Aim of increasing cost consciousness and reducing costsRCT in an inpatient internal medicine service of an urban public hospital over 6 months6 medical services were randomly assigned to intervention or control: 5,219 patients (1,859 intervention from 22 teams & 3,360 controls from 46 teams)USD (1990/1991)

Inpatient charges (bed, tests and drugs)
LOS, time in motionMicrocomputer workstations, linked to a comprehensive EMR system for all inpatient order vs. hand-written ordersTotal charges per admission were significantly less (mean difference: $887, 12.7% reduction) for intervention teams than for control teams, with similar differences in bed charges, test charges, and drug charges. Hospital stays for intervention admissions were 0.89 day (10.5%) shorter than for controls (p = 0.11). This would amount to more than $3 million in charges annually for that hospital’s medicine service
Weingart (2009)291
U.S.
Cost analysisTo understand the potential benefits of medication safety alerts in ambulatory care using a (CPOE)A multifaceted study from January 1 through June 30 2006. An expert panel reviewed a sample of common drug interaction alerts, estimating the likelihood and severity of ADEs associated with each alert, the likely injury to the patient, and the health care utilization required to address each ADE279, 476 alerted prescriptions written by 2,321 ambulatory care cliniciansUSD (2006) Hospitalization, emergency room visit, office visit, filled prescriptionADEs and related injuriesPotential benefit of electronic prescribing with decision support based on expert panel estimatesAlerts potentially resulted in a cost savings of $402,619 (IQR, $141,012 to $1,012,386). Drug alerts have the potential to prevent harm and reduce health care costs
*

indicates outcomes noted as being the primary outcome by the paper’s authors

Abbreviations = ADE = adverse drug event, AMI = acute myocardial infarction; CC = care considerations; CDSS=computerized decision support system; CHF = congestive heart failure; CMS = Center for Medicare and Medicaid Services; COPD = Chronic Obstructive Pulmonary Disease; CPOE=computerized physician order entry; CPR computer-based patient record; CVR = cardiovascular risk; DRG = diagnosis related group; EMR = electronic medical record; ER = emergency room; ESCHM = European Society of Cardiology and other societies for Hypercholesterolemia Management; HF=heart failure; HMO = health maintenance organization; ICU=intensive care unit; IHD=ischemic heart disease; IQR = interquartile range JCAHO = Joint Commission for Accreditation of Healthcare Organizations; LOS = length of stay; pmpm = per member per month; POE = physician order entry; QALY = Quality Adjusted Life Year; QOL = quality of life; RCT = randomized controlled trial; Rx = treatment; SD = standard deviation; USD = United States Dollars

From: Appendix C, Evidence Tables

Cover of Enabling Medication Management Through Health Information Technology
Enabling Medication Management Through Health Information Technology.
Evidence Reports/Technology Assessments, No. 201.
McKibbon KA, Lokker C, Handler SM, et al.

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