Model-based cost-effectiveness analysis of interventions aimed at preventing medication error at hospital admission (medicines reconciliation)
Model-based cost-effectiveness analysis of interventions aimed at preventing medication error at hospital admission (medicines reconciliation)
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DOI：
10.1111/j.1365-2753.2008.01000.x
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发表时间：
2009-04-01
影响因子：
2.4
通讯作者：
Czoski-Murray, Carolyn
中科院分区：
文献类型：
--
作者：
Karnon, Jonathan;Campbell, Fiona;Czoski-Murray, Carolyn
用药差错可能导致可预防的不良药物事件(PADES)，具有重大的成本和健康影响。差错经常发生在护理界面，已经设计了各种干预措施来减少入院时的用药差错。本研究的目的是评估存在有效性证据的一系列此类干预措施的增量成本和效果[以质量调整生命年(QALY)衡量]。方法采用先前发表的用药差错模型来描述从入院时发生的差错到PADES的发生。基线模型使用基于文献的值填充，然后根据观测输出进行校准。通过对入院时预防用药差错的干预措施的系统回顾，得出了效果的证据。结果与基线情景相比，所有5种干预措施都具有极高的成本效益。药剂师主导的协调干预具有最高的预期净收益，QALY值为10/000的情况下，成本效益超过60%的概率超过60%。结论药物差错模型提供了合理有力的证据，表明某种形式的干预改善药物协调是对NHS资源的成本效益利用。少数已确定的用药差错干预研究报告的有效性存在差异，这表明在制定干预措施时以及在评估干预措施时都需要非常注意细节，并可能证明对纳入的干预措施进行不止一种规格的初步评估是合理的。
Rationale Medication errors can lead to preventable adverse drug events (pADEs) that have significant cost and health implications. Errors often occur at care interfaces, and various interventions have been devised to reduce medication errors at the point of admission to hospital. The aim of this study is to assess the incremental costs and effects [measured as quality adjusted life years (QALYs)] of a range of such interventions for which evidence of effectiveness exists.Methods A previously published medication errors model was adapted to describe the pathway of errors occurring at admission through to the occurrence of pADEs. The baseline model was populated using literature-based values, and then calibrated to observed outputs. Evidence of effects was derived from a systematic review of interventions aimed at preventing medication error at hospital admission.Results All five interventions, for which evidence of effectiveness was identified, are estimated to be extremely cost-effective when compared with the baseline scenario. Pharmacist-led reconciliation intervention has the highest expected net benefits, and a probability of being cost-effective of over 60% by a QALY value of 10 pound 000.Conclusions The medication errors model provides reasonably strong evidence that some form of intervention to improve medicines reconciliation is a cost-effective use of NHS resources. The variation in the reported effectiveness of the few identified studies of medication error interventions illustrates the need for extreme attention to detail in the development of interventions, but also in their evaluation and may justify the primary evaluation of more than one specification of included interventions.