A tiered approach is more cost effective than traditional pharmacist-based review for classifying computer-detected signals as adverse drug events

J Biomed Inform. 2003 Feb-Apr;36(1-2):92-8. doi: 10.1016/s1532-0464(03)00059-5.


Objective: To develop a cost-efficient method for identifying adverse drug events (ADEs) and medication errors (MEs) identified using outpatient electronic medical records within ambulatory settings.

Design: Comparison of sensitivity and cost of "traditional" pharmacist based approach to identifying ADEs and MEs during a 4 month period with a tiered approach.

Results: The proportion of computer generated signals analyzed identified as ADEs were similar using the two approaches while the number of MEs was nearly double with tiered reviews suggesting the same or better sensitivity. Traditional pharmacist review cost $68.70 US dollars to detect an ADE and tiered approach cost only $42.40.

Conclusion: Tiered review of ADEs and MEs by personnel with increasing clinical capability is more cost-efficient than pharmacist review.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Adverse Drug Reaction Reporting Systems / economics*
  • Aged
  • Algorithms*
  • Ambulatory Care / economics*
  • Ambulatory Care / methods*
  • Cost-Benefit Analysis / methods*
  • Database Management Systems
  • Expert Systems*
  • Female
  • Humans
  • Information Storage and Retrieval / methods
  • Male
  • Medication Errors / classification*
  • Medication Errors / economics*
  • Medication Errors / prevention & control
  • Middle Aged
  • Patient Care Team
  • Pharmaceutical Services / economics
  • Reproducibility of Results
  • Sensitivity and Specificity