Relative to the volume of research evidence that has examined the impact of HIT on the medication management process, the amount of literature evaluating the economic impact of these systems lags far behind.2
Compounding the problem is the fact that the quality of the available economic evidence is poor. For example, most of the studies reviewed here would not be considered full economic evaluations.1
Only 16% of the papers measured the cost per successful patient outcome, and 84% simply provided cost data. Economic evaluation of health services is a comparative analysis of alternative courses of action in terms of both their costs and consequences.1
The goal is to identify which intervention is most efficient. The main categories of costs of healthcare interventions are the costs associated with the use of resources within the health sector, those used by patients and their families, those used in other sectors, and productivity changes ().37
The cost may also include downstream costs associated with ongoing treatment, or the management of adverse events or side effects of the treatment. The consequences are the relevant outcomes of interest caused by an intervention (either clinically measured or reported by the patient). The outcomes could be expressed in terms of final health outcomes such as gains in health-related quality of life, or in terms of intermediate health outcomes (eg, mm Hg in hypertension). However, in general, one should choose an effectiveness measure relating to a final outcome.38
Cost components of economic evaluation in healthcare.
Very few of the studies included the large cost items such as the purchase of new software (capital outlay) or implementation costs (eg, training costs, maintenance costs). Additionally, the settings where HIT programs had already been introduced had existing technology infrastructure (eg, EMRs) to support the new interventions; this may not be the case in many areas. Additionally, whether the technology is commercial or home-grown (eg, academic health center) will have implications for start-up costs and organizational savvy.
The heterogeneity (eg, cost elements) between studies was so great that combining the studies was not possible. This has meant that, while studies have been broadly grouped according to setting and type of intervention, the review has been presented on a study-by-study basis, rather than as a complete synthesis of the results. This makes the interpretation of the results somewhat complicated and commenting on the cost-effectiveness of HIT for medication management difficult. Many of the studies provided evidence of some reductions in costs in certain areas due to the intervention (eg, reduction in drug costs and hospital length of stay). The assumption is that these changes will likely result in long-term cost savings and improved quality of care. These potential cost savings are speculative and are not conclusive.
Despite the limitations of the literature, the great strength of this review lies in the fact that extensive searches were undertaken and included studies that reported any relevant information on the economics of the impact of HIT on medication management. The systematic review searches were updated in July 2010, and should therefore provide a comprehensive up-to-date review of the evidence available. Furthermore, to the best of our knowledge, this is the first systematic review conducted to combine the available research in this area.
Adoption of newer technologies needs to be based on formal evaluation of whether the additional benefit is worth the additional cost. Given the tension between the benefits of HIT for medication management and the high up-front costs, decision-makers deciding whether to implement these technologies need to better understand how and when financial benefits of such systems accrue. These types of analyses are important for well-informed decision-making. In addition, one needs to bear in mind that the effectiveness of any given system is dependent on the system's design, implementation, the user(s) of the system, and the setting into which the system is being introduced. However, because of the focus of our review (ie, systematic review of economic evaluations), we did not conduct a detailed review of implementation issues; this is left for future research.