JMIR Publications

ABSTRACT

Background:

Medication-related harm, including adverse drug reactions (ADRs) and medication errors, represents a significant burden in clinical care. Digital health technology (DHT) interventions can potentially improve medication safety outcomes. There is a lack of comprehensive reviews assessing the economic impact of these interventions, which is essential to inform healthcare policy.

Objective:

To systematically review economic evaluations of DHT interventions aimed at improving medication safety outcomes.

Methods:

A systematic search was conducted across PubMed, Scopus, and EBSCOhost databases. We included studies reporting full economic evaluations of DHT interventions to reduce ADRs and medication errors compared to usual care. Data extraction included study characteristics, design, cost elements, key findings, and quality of reporting. A narrative synthesis was conducted to summarize the findings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed for this systematic review. The reporting quality of the included studies was assessed using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guideline.

Results:

Thirteen studies met the inclusion criteria, with the majority being cost-effectiveness analyses (CEA) (n=8, 61.54%), cost-benefit analyses (CBA) (n=3, 23.08%), one cost-utility analysis (CUA) study, and another study combined CEA and CUA. The DHT interventions assessed were electronic clinical decision support systems (CDSS) integrated with computerized provider order entry (CPOE) (n=9, 69.23%) and automated drug dispensing systems, including automatic unit dose dispensing, bar-code medication administration, and automatic dispensing cabinets (n=4, 30.77%). Two studies combined CDSS with pharmacist-led interventions. Most CEA studies (n=8, 88.89%) demonstrated that DHT interventions are cost-effective in reducing medication errors and ADRs compared to paper-based systems or usual pharmaceutical care. Only one CEA study showed an exceptionally high incremental cost-effectiveness ratio without stating a willingness-to-pay threshold. Two CBA studies showed that DHT interventions yield positive returns on investment (ROI) within 3 to 4.25 years after implementation, while one did not specify the ROI timeframe. A CUA study showed that DHT interventions are potentially cost-saving for society.

Conclusions:

Conclusions:

Most DHT interventions are potentially cost-effective in improving medication safety outcomes. While initial substantial investments are required, the long-term benefits justify the costs. Further studies should explore designing DHT with interactive features and explicit action plans to improve the effectiveness of these strategies in reducing ADRs and errors, thereby increasing clinical benefit and economic viability.