Hematology Service Clinical Pharmacology Service Clinical Pharmacy Service Informatics Service Documentation Service, University Clinic of Navarra, Pamplona, Spain.
J Thromb Haemost. 2011 Jun;9(6):1108-15. doi: 10.1111/j.1538-7836.2011.04282.x.
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.
To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4year period.
PATIENTS/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.
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.
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.
预防静脉血栓栓塞症（VTE）是提高住院患者安全性的首要任务。在全球范围内，人们越来越关注适当的血栓预防措施使用不足的问题。计算机化决策支持可改善血栓预防措施的实施并降低住院患者 VTE 的发生率。然而，目前尚未对此方法进行经济评估。
评估电子警报（e-alert）系统在 4 年内预防住院患者 VTE 的经济影响。
患者/方法：纳入 2005 年至 2009 年上半年期间单一机构住院的所有患者（n=32280）。对所有住院期间发生的 VTE 病例进行随访，并收集诊断和管理的直接费用。
e-alert 可持续降低住院患者 VTE 的发生率，比值比（OR）为 0.50（95%置信区间，0.29-0.84），对内科患者的影响尤其显著，OR 为 0.44（95%置信区间，0.22-0.86）。未观察到预防相关出血增加。在我们的环境中，住院 VTE 发作的平均直接成本（住院期间和出院后）为 7058 欧元。实施 e-alert 后，每位住院患者的直接成本从 21.6 欧元降至 11.8 欧元，而增加的血栓预防和 e-alert 的开发分别使每位患者的成本增加了 3 欧元和 0.35 欧元。因此，实施 e-alert 可使每位住院患者的净成本节省 6.5 欧元。如果考虑到西班牙所有住院患者，每年的总节省费用将接近 3000 万欧元。
e-alert 是住院患者血栓预防策略的有用且具有成本效益的工具。通过实施 e-alert，可减少血栓栓塞并发症并降低成本。
