title: Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients.
abstract: OBJECTIVE
  The prevention of venous thromboembolism (VTE) is a priority for improved safety in hospitalised patients. Worldwide, there is growing concern over the undersuse of appropriate thromboprophylaxis. Computerised decision support improves the implementation of thromboprophylaxis and reduces inpatient VTE. However, an economic assessment of this approach has not yet been performed.
  
  
  OBJECTIVE
  To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4year period.
  
  
  METHODS
  All hospitalised patients at a single institution during the first semesters of 2005-2009 (n=32280) were included. All cases of VTE developed during hospitalisation were followed and direct costs of diagnosis and management collected.
  
  
  RESULTS
  E-alerts achieved a sustained reduction of the incidence of in-hospital VTE, OR 0.50 (95% CI, 0.29-0.84), the impact being especially significant in medical patients, OR 0.44 (95% CI, 0.22-0.86). No increase in prophylaxis-related bleeding was observed. In our setting, the mean direct cost (during hospitalisation and after discharge) of an in-hospital VTE episode is €7058. Direct costs per single hospitalised patient were reduced after e-alerts from €21.6 to €11.8, while the increased use of thromboprophylaxis and the development of e-alerts meant €3 and €0.35 per patient, respectively. Thus, the implementation of e-alerts led to a net cost saving of €6.5 per hospitalised patient. Should all hospitalised patients in Spain be considered, total yearly savings would approach €30million.
  
  
  CONCLUSIONS
  E-alerts are useful and cost-effective tools for thromboprophylaxis strategy in hospitalised patients. Fewer thromboembolic complications and lower costs are achieved by its implementation.
authors.affiliation: Hematology Service Clinical Pharmacology Service Clinical Pharmacy Service Informatics Service Documentation Service, University Clinic of Navarra, Pamplona, Spain. rlecumber@unav.es
authors.forename: R
authors.initials: R
authors.lastname: Lecumberri
authors.forename: E
authors.initials: E
authors.lastname: Panizo
authors.forename: A
authors.initials: A
authors.lastname: Gomez-Guiu
authors.forename: S
authors.initials: S
authors.lastname: Varea
authors.forename: E
authors.initials: E
authors.lastname: García-Quetglas
authors.forename: M
authors.initials: M
authors.lastname: Serrano
authors.forename: A
authors.initials: A
authors.lastname: García-Mouriz
authors.forename: M
authors.initials: M
authors.lastname: Marqués
authors.forename: A
authors.initials: A
authors.lastname: Gómez-Outes
authors.forename: J A
authors.initials: JA
authors.lastname: Páramo
mesh_terms: D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006760:Hospitalization; D006801:Humans; D050316:Medical Order Entry Systems / Q000191:economics*; D011292:Premedication / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D013030:Spain; D054556:Venous Thromboembolism / Q000191:economics / Q000517:prevention & control*