Abstract
Objective The redundancy of routine laboratory tests in medicine has become increasingly more
apparent in the age of electronic medical records (EMRs). The purpose of this study
was to determine whether targeted screening strategies are more cost-effective than
the current standard of universal screening of pregnant women for immunity to rubella.
Study Design A decision analysis model was used to evaluate three strategies: universal screening,
screening if a previous titer was not available, and use of an “alert” in the EMR
to prompt screening. Cost, probability, and utility values were derived from the literature
and institutional data from Lyndon B. Johnson General Hospital. One-way sensitivity
analyses were performed on all cost and probability values.
Results The strategy of an EMR alert was most cost-effective, with a cost of $0.27 per quality-adjusted
life years (QALY). The model was robust to all costs and probability values over their
respective ranges.
Conclusions Although all strategies were cost-effective compared with traditional industry benchmarks
of $50,000/QALY, the EMR alert strategy is most cost-effective. Implementing an EMR
alert may lead to a more cost-effective approach to prenatal evaluation of rubella
immunity.
Keywords
cost-effectiveness - electronic medical record - rubella screening - vaccination -
decision analysis
