Improving laboratory monitoring of medications: An economic analysis alongside a clinical trial

David H. Smith, Adrianne C. Feldstein, Nancy A. Perrin, Xiuhai Yang, Mary M. Rix, Marsha A. Raebel, David J. Magid, Steven R. Simon, Stephen B. Soumerai

Research output: Contribution to journalArticlepeer-review


Objective: To test the efficiency and cost-effectiveness of interventions aimed at enhancing laboratory monitoring of medication. Study Design: Cost-effectiveness analysis. Methods: Patients of a not-for-profit, group-model HMO were randomized to 1 of 4 interventions: an electronic medical record reminder to the clinician, an automated voice message to patients, pharmacy-led outreach, or usual care. Patients were followed for 25 days to determine completion of all recommended baseline laboratory-monitoring tests. We measured the rate of laboratory test completion and the cost-effectiveness of each intervention. Direct medical care costs to the HMO (repeated testing, extra visits, and intervention costs) were determined using trial data and a mix of other data sources. Results:The average cost of patient contact was $5.45 in the pharmacy-led intervention, $7 in the electronic reminder intervention, and $4.64 in the automated voice message reminder intervention. The electronic medical record intervention was more costly and less effective than other methods. The automated voice message intervention had an incremental cost-effectiveness ratio (ICER) of $47 per additional completed case, and the pharmacy intervention had an ICER of $64 per additional completed case. Conclusions: Using the data available to compare strategies to enhance baseline monitoring, direct clinician messaging was not an efficient use of resources. Depending on a decision maker's willingness to pay, automated voice messaging and pharmacy-led efforts can be efficient choices to prompt therapeutic baseline monitoring, but direct clinician messaging is probably a less efficient use of resources.

Original languageEnglish (US)
Pages (from-to)281-289
Number of pages9
JournalAmerican Journal of Managed Care
Issue number5
StatePublished - May 2009
Externally publishedYes

ASJC Scopus subject areas

  • Health Policy

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