title: Cost-effectiveness analysis of a hospital electronic medication management system.
abstract: OBJECTIVE
  To conduct a cost-effectiveness analysis of a hospital electronic medication management system (eMMS).
  
  
  METHODS
  We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs.
  
  
  RESULTS
  The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63-66 (US$56-59) per admission (A$97 740-$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially.
  
  
  CONCLUSIONS
  The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost-effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.
authors: Professor and Director, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia, 2109 johanna.westbrook@mq.edu.au.
authors: Johanna I
authors: JI
authors: Westbrook
authors: Senior Research Fellow, Deakin Health Economics, Deakin Population Health Strategic Research Centre, Faculty of Health, Deakin University, Melbourne, Australia, 3125.
authors: Elena
authors: E
authors: Gospodarevskaya
authors: Biostatistician, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia, 2109.
authors: Ling
authors: L
authors: Li
authors: eMedicines Management Pharmacist, St Vincent's Hospital, Sydney, Australia, 2010.
authors: Katrina L
authors: KL
authors: Richardson
authors: Chief Information Officer, St Vincent's Health Australia, Sydney, Australia, 2010.
authors: David
authors: D
authors: Roffe
authors: eMedicines Management Pharmacist, St Vincent's Hospital, Sydney, Australia, 2010.
authors: Maureen
authors: M
authors: Heywood
authors: Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, and UNSW Medicine, University of New South Wales, Sydney, Australia, 2052.
authors: Richard O
authors: RO
authors: Day
authors: Professor, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia, 4059.
authors: Nicholas
authors: N
authors: Graves
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics / Q000517:prevention & control*; D017721:Hospital Costs; D006801:Humans; D050316:Medical Order Entry Systems / Q000191:economics*; D008510:Medication Systems, Hospital / Q000191:economics*; D018803:Models, Economic; D009517:New South Wales
keywords: CPOE; adverse drug events; cost-effectiveness; decision analytic model hospital; electronic medication management system; electronic prescribing; inpatient care; medication error