OBJECTIVES: Mediaction errors (ME) and the consequent preventable adverse drug events (pADE) are a major burden to inpatient care. They not only cause patient harm but as a result of this prolonged length of stay (LOS) and increased healthcare cost may arise. CPOE (Computerized physician order entry or computer provided order entry) with or without a clinical decision support tool (CDS) have been shown to increase patient safety. Due to the increasing burden on healthcare financing it is important to seek cost-effective solutions. Our aim was to collect studies examining CPOE systems in inpatient care with cost or other resource utilization related outcomes, and to evaluate these studies from a methodological perspective, with special regard to full economic evaluations.

METHODS: We conducted a systematic search of Scopus, PubMed and Web of Science databases. Search terms were determined according to PICO. Non-English papers and studies providing no original data were excluded.

RESULTS: Following a screening of 1693 abstracts, 67 full text articles were analyzed of which 27 met the inclusion criteria. We have identified 18 partial and 9 full economic evaluations. In this study we analyzed the full economic evaluations. Except 1 cost-benefit and 1 cost-utility analysis all the publications included were cost-effectiveness studies. No cost-minimization studies were found. The clinical outcomes are dominated by pADE, although LOS (1 case), QALY (1 case) are also apparent. The input parameters on the contrary are quite different. Every analysis have demonstrated cost-reducing and patient safety enhancing effect but differences are present in methods (e.g. perspective, discounting, duration, inflation, sensitivity), inputs and definitions (e.g. definition of ADE).

CONCLUSIONS: Differences in methods and quality in health-economic analyses concerning CPOE are raising questions about the comparability of these studies. This might be one of the reasons of the lack of agreement on the cost-effectiveness of CPOE.