Modelling the expected net benefits of interventions to reduce the burden of medication errors
Modelling the expected net benefits of interventions to reduce the burden of medication errors
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DOI：
10.1258/jhsrp.2007.007011
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发表时间：
2008-04-01
影响因子：
2.4
通讯作者：
Tappenden, Paul
中科院分区：
文献类型：
--
作者：
Karnon, Jonathan;McIntosh, Aileen;Tappenden, Paul
目的：本研究的目的是评估三种关键干预措施（计算机化医嘱输入 [CPOE]、额外病房药剂师和条形码）的潜在成本和收益，以帮助优先考虑减少用药错误的研究。方法：开发了一个通用模型结构来描述医院用药错误的发生率和影响。该模型遵循从药物途径的不同阶段的用药错误点到未检测到的错误的结果的路径。该模型是根据对用药错误文献的系统回顾并结合新颖的概率校准方法而构建的。成本范围适用于干预措施、可预防药物不良事件 (pADE) 的治疗以及 ADE 造成的健康损失的价值。结果：该模型预测，英国一家拥有 400 个床位的急性医院治疗 pADE 的年度医疗服务成本在 0.3 英镑到 000 万英镑之间。仅包括卫生服务成本，尚不确定这三种干预措施中的任何一种是否会产生积极的净效益，特别是在假设干预成本较高的情况下。当考虑到健康损失的货币价值时，所有三种干预措施都很有可能产生积极的净效益，在五年的时间范围内，CPOE 的平均估计约为 31.5 百万英镑。结论：结果确定了针对用药错误的干预措施的潜在成本效益，并确定了在设计用药错误干预措施的初步评估时应特别解决的成本效益的关键驱动因素。
Objectives: The aim of this study is to estimate the potential costs and benefits of three key interventions (computerized physician order entry [CPOE], additional ward pharmacists and bar coding) to help prioritize research to reduce medication errors.Methods: A generic model structure was developed to describe the incidence and impacts of medication errors in hospitals. The model follows pathways from medication error points at alternative stages of the medication pathway through to the outcomes of undetected errors. The model was populated from a systematic review of the medication errors literature combined with novel probabilistic calibration methods. Cost ranges were applied to the interventions, the treatment of preventable adverse drug events (pADEs), and the value of the health lost as a result of an ADE.Results: The model predicts annual health service costs of between 0.3 pound million and 0 million for the treatment of pADEs in a 400-bed acute hospital in the UK. Including only health service costs, it is uncertain whether any of the three interventions will produce positive net benefits, particularly if high intervention costs are assumed. When the monetary value of lost health is included, all three interventions have a high probability of producing positive net benefits with a mean estimate of around 31.5 pound million for CPOE over a five-year time horizon.Conclusions: The results identify the potential cost-effectiveness of interventions aimed at medication errors, as well as identifying key drivers of cost-effectiveness that should be specifically addressed in the design of primary evaluations of medication error interventions.