Insani Widya Norma, Zakiyah Neily, Puspitasari Irma Melyani, Permana Muhammad Yorga, Parmikanti Kankan, Rusyaman Endang, Suwantika Auliya Abdurrohim
Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.
Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia.
J Med Internet Res. 2025 Feb 5;27:e65546. doi: 10.2196/65546.
Medication-related harm, including adverse drug events (ADEs) and medication errors, represents a significant iatrogenic burden in clinical care. Digital health technology (DHT) interventions can significantly enhance medication safety outcomes. Although the clinical effectiveness of DHT for medication safety has been relatively well studied, much less is known about the cost-effectiveness of these interventions.
This study aimed to systematically review the economic impact of DHT interventions on medication safety and examine methodological challenges to inform future research directions.
A systematic search was conducted across 3 major electronic databases (ie, PubMed, Scopus, and EBSCOhost). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. Two independent investigators conducted a full-text review after screening preliminary titles and abstracts. We adopted recommendations from the Panel on Cost-Effectiveness in Health and Medicine for data extraction. A narrative analysis was conducted to synthesize clinical and economic outcomes. The quality of reporting for the included studies was assessed using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines.
We included 13 studies that assessed the cost-effectiveness (n=9, 69.2%), cost-benefit (n=3, 23.1%), and cost-utility (n=1, 7.7%) of DHT for medication safety. Of the included studies, more than half (n=7, 53.9%) evaluated a clinical decision support system (CDSS)/computerized provider order entry (CPOE), 4 (30.8%) examined automated medication-dispensing systems, and 2 (15.4%) focused on pharmacist-led outreach programs targeting health care professionals. In 12 (92.3% ) studies, DHT was either cost-effective or cost beneficial compared to standard care. On average, DHT interventions reduced ADEs by 37.12% (range 8.2%-66.5%) and medication errors by 54.38% (range 24%-83%). The key drivers of cost-effectiveness included reductions in outcomes, the proportion of errors resulting in ADEs, and implementation costs. Despite a significant upfront cost, DHT showed a return on investment within 3-4.25 years due to lower cost related with ADE treatment and improved workflow efficiency. In terms of reporting quality, the studies were classified as good (n=10, 76.9%) and moderate (n=3, 23.1%). Key methodological challenges included short follow-up periods, the absence of alert compliance tracking, the lack of ADE and error severity categorization, and omission of indirect costs.
DHT interventions are economically viable to improve medication safety, with a substantial reduction in ADEs and medication errors. Future studies should prioritize incorporating alert compliance tracking, ADE and error severity classification, and evaluation of indirect costs, thereby increasing clinical benefits and economic viability.
与药物治疗相关的危害，包括药物不良事件（ADEs）和用药错误，是临床护理中一个重大的医源性负担。数字健康技术（DHT）干预措施可显著提高用药安全性。尽管DHT对用药安全的临床有效性已得到相对充分的研究，但对这些干预措施的成本效益却知之甚少。
本研究旨在系统评价DHT干预措施对用药安全的经济影响，并探讨方法学挑战，为未来的研究方向提供参考。
在3个主要电子数据库（即PubMed、Scopus和EBSCOhost）中进行系统检索。本系统评价遵循PRISMA（系统评价和Meta分析的首选报告项目）指南。两名独立研究者在筛选初步标题和摘要后进行全文审查。我们采用了健康与医学成本效益小组的建议进行数据提取。进行叙述性分析以综合临床和经济结果。使用CHEERS（综合健康经济评价报告标准）指南评估纳入研究的报告质量。
我们纳入了13项评估DHT对用药安全的成本效益（n = 9，69.2%）、成本效益（n = 3，23.1%）和成本效用（n = 1，7.7%）的研究。在纳入的研究中，超过一半（n = 7，53.9%）评估了临床决策支持系统（CDSS）/计算机化医嘱录入系统（CPOE），4项（30.8%）研究了自动配药系统，2项（15.4%）研究聚焦于针对医护人员的药师主导的推广项目。在12项（92.3%）研究中，与标准护理相比，DHT具有成本效益或成本效益优势。平均而言，DHT干预措施使ADEs减少了37.12%（范围为8.2% - 66.5%），用药错误减少了54.38%（范围为24% - 83%）。成本效益的关键驱动因素包括结果的减少、导致ADEs的错误比例以及实施成本。尽管前期成本较高，但由于与ADE治疗相关的成本降低以及工作流程效率提高，DHT在3 - 4.25年内显示出投资回报。在报告质量方面，这些研究被分类为良好（n = 10，76.9%）和中等（n = 3，23.1%）。关键的方法学挑战包括随访期短、缺乏警报依从性跟踪、缺乏ADE和错误严重程度分类以及间接成本的遗漏。
DHT干预措施在经济上可行，可改善用药安全，显著减少ADEs和用药错误。未来的研究应优先纳入警报依从性跟踪、ADE和错误严重程度分类以及间接成本评估，从而提高临床效益和经济可行性。
