Patient information systems are not more expensive than leaflets

Editor—Graham et al, who compared a touch screen system with leaflets for providing women with information on prenatal tests,¹ and Wyatt in his commentary² may be too conservative in their conclusions. Graham et al mention the cost of developing the system and Wyatt says because there is limited evidence of benefit for these expensive tools over well designed leaflets they should be used only in the context of rigorous research studies. However, the study did not include an economic comparison of the use of the computer and leaflets. A full economic analysis would compare the estimated development costs of £25 000 and the subsequent maintenance costs with the costs of the alternative. It would then compare the costs with the marginal benefits during the period that the system is in use.

If the system is readily transferable to another site, development costs at that other site would not be anywhere near £25 000. Given the high volume of use that could be achieved in antenatal care, the cost per patient could be small. For example, use of a computer with touch screen and a printer costing £2000 capital with 5% maintenance in years 2-4 might have a four year cost (without discounting) of £2600. Aberdeen Maternity Hospital had 4734 deliveries in 1997, a mean of 13 a day.¹ If, over four years, 10 000 women (53%) used the system, the attributable cost per woman is 26 pence. This may compare favourably with the cost of leaflets. In our own study of patients with cancer,³ maintaining a computer system (and replacing it after four years) was cheaper than giving full access to the expensive cancer booklets (typically £3.00 each).

Although Graham et al found no difference in knowledge, they did note a reduction in anxiety in the intervention group. Is the possible reduction in anxiety worth 26 pence per woman? The marginal benefits are attenuated by the fact that, as Graham et al and Wyatt point out, this group in the Aberdeen population had a good baseline knowledge of prenatal tests, so only minor improvements in knowledge may be achievable in that context. More than half of their sample (55%) came from affluent areas. Evaluation of the system in an area of high deprivation, where non-print media may have benefits over the written word among a population with lower literacy and knowledge levels, may show different outcomes.

Further evaluation, including economic analysis, of the use of the system in an area with higher levels of deprivation is worth-while and would also show the feasibility of “technology transfer” for such systems. However, the simple costing exercise in this letter may show that Wyatt is wrong and that the system should continue in routine use in Aberdeen.