Improving laboratory monitoring of medications: an economic analysis alongside a clinical trial.
OBJECTIVE
To test the efficiency and cost-effectiveness of interventions aimed at enhancing laboratory monitoring of medication.


METHODS
Cost-effectiveness analysis.


METHODS
Patients of a not-for-profit, group-model HMO were randomized to 1 of 4 interventions: an electronic medical record reminder to the clinician, an automated voice message to patients, pharmacy-led outreach, or usual care. Patients were followed for 25 days to determine completion of all recommended baseline laboratory monitoring tests. We measured the rate of laboratory test completion and the cost-effectiveness of each intervention. Direct medical care costs to the HMO (repeated testing, extra visits, and intervention costs) were determined using trial data and a mix of other data sources.


RESULTS
The average cost of patient contact was $5.45 in the pharmacy-led intervention, $7.00 in the electronic reminder intervention, and $4.64 in the automated voice message reminder intervention. The electronic medical record intervention was more costly and less effective than other methods. The automated voice message intervention had an incremental cost-effectiveness ratio (ICER) of $47 per additional completed case, and the pharmacy intervention had an ICER of $64 per additional completed case.


CONCLUSIONS
Using the data available to compare strategies to enhance baseline monitoring, direct clinician messaging was not an efficient use of resources. Depending on a decision maker's willingness to pay, automated voice messaging and pharmacy-led efforts can be efficient choices to prompt therapeutic baseline monitoring, but direct clinician messaging is probably a less efficient use of resources.
Center for Health Research, Kaiser Permanente, 3800 N Interstate Ave, Portland, OR 97227, USA. david.h.smith@kpchr.org
David H
DH
Smith
Adrianne C
AC
Feldstein
Nancy A
NA
Perrin
Xiuhai
X
Yang
Mary M
MM
Rix
Marsha A
MA
Raebel
David J
DJ
Magid
Steven R
SR
Simon
Stephen B
SB
Soumerai
D019411:Clinical Laboratory Techniques / Q000191:economics*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis / Q000379:methods; D016903:Drug Monitoring / Q000191:economics / Q000379:methods*; D006801:Humans; D010349:Patient Compliance; D017010:Reminder Systems / Q000191:economics