Evidence Table 8aSummary of full economic evaluation studies

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

Cost elements
Effective-ness measureIntervention and alternative being evaluatedMain economic findings
Fretheim (2006)55
Fretheim (2006)56
Norway
Cost-effectiveness analysesCompared costs and effects of a multifaceted intervention aimed at improving prescribing of anti- hypertensive and cholesterol lowering drugs compared with usual care.Using data from a cluster- RCT of private practices, the cost- effectiveness included the cost incurred per additional patient started on a thiazide rather than another anti- hypertensive drug.Intervention: 73 practices with 70 included in analysis;
control: 73 with 69 included in analysis
Perspec-tive of the health care system, (1 year)2002 USD (used 2002 avg. exchange rate from Norwegian kroner)

Development of software; training of outreach visitors; printed material; travel; cost of pharmacists doing outreach; admin costs; opportunity cost of physician time; technical support; drug expenditure; number of consultations per patient; laboratory tests
Number of patients prescribed thiazides for hypertension, number of patients that had a cardiovas-cular risk assessment done, number of patients who achieved treatment target goal (BP, LDL, total cholesterol)multifaceted intervention:
  1. educational outreach visits to clinics;
  2. audit & feedback on current adherence to guidelines & recommendations;
  3. computerized reminders to physicians during pt encounter vs. passive dissemination of guidelines through national medical journal
The cost- effectiveness of the intervention was USD$454 per additional patient started on thiazides.
Karnon (2008)278
U.K.
Cost-utility analysisTo estimate the net benefits of interventions that aim to reduce the impact of medication errors, either through prevention or detection.A decision tree model to describe a series of error points and subsequent error detection points in pathways through the medication process in a generic secondary care setting. Assumed an acute hospital size of 400 bedspopulated model with quantitative estimates to describe the incidence and impacts of medication errors. The effective-ness of potential interventions was estimated by describing impact of interventions on error incidence and detection rates, which feed through to alter the estimated frequency of medication errors and pADEs.Five years to represent the predicted useful life of the IT-based interventions.U.K. sterling (2006)

Monetary values were assigned to the interventions, efficiency savings, treatment of, and the health effects of pADEs.
Quality of life utility decrements associated with experiencing a pADECPOE vs. additional ward pharmacists vs. bar codingThe fully estimated net benefits of the three interventions are dominated by the estimated monetary valuations of the health effects of pADEs, with mean net benefits of £31.5, £27.25, and £13.1 million over a five year time horizon for CPOE, ward pharmacists and bar coding, respectively.
Plaza, V. (2005)279
Spain
Cost- effectivenessTo evaluate the cost- effective-ness of an intervention to promote the recommendation of the Global Initiative for Asthma compared with standard practicePhysicians were randomized to CDSS offering recommendations or no CDSS groups in a multicenter, prospective, pragmatic study. Eligible patients were followed for 1 year.
The incremental cost-effectiveness ratio was defined as the increase in total cost per patient divided by the change in QoL score
20 physicians (10 pulmonologists and 10 primary care physicians) & (included 198 asthmatic patients)Societal perspective & national health system (i.e. payer)Euros (2001)

Direct (resource x unit cost, treatment costs) and indirect (time off work due to medical visits) costs for societal perspective and direct costs for payer perspective
Difference in QOL using St. Georges Respiratory Questionnaire. GRQ, healthcare resources consumed, number of medical visits, hospitalizations, asthma treatment, blood analysis, spirometry, chest radiographsCDSS vs. no CDSSNot clear what currency the results are presented in. Hard to decipher but it may be that from the societal perspective the intervention was dominant (less costly and more effective) and from the payer perspective the ICER was $61/percentage point reduction in SGRQ scale
Rosser (1992)139
Canada
Cost- effectiveness analysisTo assess the effect of three computer-ized reminder systems on compliance with tetanus vaccination.Prospective randomized controlled trial (4 arms). Setting: Hospital Family Medicine Centre over 1 year5242 randomization patients and 2369 non- randomized patients ≥ 20 years of age not in a hospital or institutionHealth care practice (1 year)CDN (1985/1986)

Physician time, clerical and nurse time, stationary, stamps, prepaid envelope and clerical time, cost to set up computerized reminder system was not included.
Proportion of patients who received tetanus toxoid in the study year or who had a claim of vaccine-tion in the previous 10 yearsComputer- generated physician reminder, vs. telephone reminder to patient, vs. letter reminder to patient to recommend tetanus vaccination vs. control groupcost to practice per additional vaccination recorded was 22¢ to 43¢ for physician reminders, $4.43 to $5.43 for telephone reminders; and $6.05 for the letter reminders.
Wu, RC. (2007)280
Canada
Cost- effectiveness analysisTo determine the potential incremental cost-effectiveness of an electronic MOE/MAR system.Incremental cost- effectiveness analysis comparing mean effectiveness of electronic MOE/MAR vs. Standard paper ordering for prevention of ADEs. Setting: Three tertiary care teaching hospitalsN/AHealth care institution (10 years with 5% discount rate)USD (2004)

Implementation costs (software, project management, clinical team involvement and training); operating costs (support for new interface, training))
Reduction of preventable ADEs and mortality (rates obtained by review of literature)MOE/MAR (i.e. CPOE) compared with conventional paper-based systemIncremental costs for CPOE system vs. paper was $12,700 per ADE averted This value is sensitive to the ADE rate, system effectiveness of ADE reduction, system cost, and costs due to possible increase in doctor workload.
*

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

Abbreviations: ADE = adverse event; BP = blood pressure; BWH = Bringham and Women’s Hospital; CDSS = computerized decision support system; CPOE = computerized physician order entry; CVR = cardiovascular risk; ESCHM = European Society of Cardiology and other societies for Hypercholesterolemia Management; GINA = Global Initiative for Asthma; LOS = length of stay; MAR = medication administration record; MOE = medication ordering entry; pADE = preventable adverse drug events; QOL = quality of Life; RCT = randomized controlled trial; SADC = system of clinical decision support; SGRQ = St. George Respiratory Questionnaire; 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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