Table 2.

Intervention studies (Change in cost due to change in actual guidelines)

Reference/Design	Country/setting	Inclusion criteria/intervention	Degree of financial saving	LOE
Newton and Young (2006); Before and after study[16]	USA	Inpatient diabetes management programme	Reduction in length of stay for patients with diabetes. Has resulted in savings of more than $2 million for the year and has yielded a 467% return on investment	2b
McMullin et-al. (2005); Intervention and control[23]	USA	Use of commercially available electronic prescribing system with integrated clinical decision support and evidence based message capability	The proportion of prescriptions for high cost drugs that were the target of this intervention to prescribers was a relative 17.5% lower among the intervention group compared with the control group	2b
Wong et-at. (2000); Intervention and control[22]	Hamilton Ontario	Multidisciplinary clinical pathway for oxygen management	Total health system costs increased by 116%	2a
Hanna et-al. (1999); Before and after study. Before data was retrospective[18]	USA	Use of a clinical pathway for patients undergoing total laryngectomy	The average hospital variable cost decreased from £3992 to £3419 per case. This represents a 14.4 reduction in costs associated with pathway implementation	2b
Roth et-al (2001); Before and after study[20]	USA	Educational intervention to decrease use of selected expensive medications	Annual saving of £66000 representing 32% decrease in use of more costly anti- coagulant and a 20% increase in the use of the less costly anticoagulant	2b
Watson et-al. (2001); Cluster randomized trial[26]	Avon England	Evaluate the effectiveness of guidelines with or without one to one educational outreach visits by community pharmacists	Mean costs reduced by 6% in practices that received mailed guidelines and educational outreach	1b

LOE: Oxford centre for Evidence-Based Medicine level of evidence (May 2001)[10]