J Am Med Inform Assoc - Cost-effectiveness of a shared computerized decision support system for diabetes linked to electronic medical records.


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CKGROUND: Computerized decision support systems (CDSSs) are believed to enhance patient care and reduce healthcare costs; however the current evidence is limited and the cost-effectiveness remains unknown.OBJECTIVE: To estimate the long-term cost-effectiveness of a CDSS linked to evidence-based treatment recommendations for type 2 diabetes.METHODS: Using the Ontario Diabetes Economic Model, changes in factors (eg, HbA1c) from a randomized controlled trial were used to estimate cost-effectiveness. The cost of implementation, development, and maintenance of the core dataset, and projected diabetes-related complications were included. The base case assumed a 1-year treatment effect, 5% discount rate, and 40-year time horizon. Univariate, one-way sensitivity analyses were carried out by altering different parameter values. The perspective was the Ontario Ministry of Health and costs were in 2010 Canadian dollars.RESULTS: The cost of implementing the intervention was $483,699. The one-year intervention reduced HbA1c by 0.2 and systolic blood pressure by 3.95 mm Hg, but increased body mass index by 0.02 kg/m?, resulting in a relative risk reduction of 14% in the occurrence of amputation. The model estimated that the intervention resulted in an additional 0.0117 quality-adjusted life year; the incremental cost-effectiveness ratio was $160,845 per quality-adjusted life-year.CONCLUSION: The web-based prototype decision support system slightly improved short-term risk factors. The model predicted moderate improvements in long-term health outcomes. This disease management program will need to develop considerable efficiencies in terms of costs and processes or improved effectiveness to be considered a cost-effective intervention for treating patients with type 2 diabetes.

Resumo Limpo

ckground computer decis support system cdsss believ enhanc patient care reduc healthcar cost howev current evid limit costeffect remain unknownobject estim longterm costeffect cdss link evidencebas treatment recommend type diabetesmethod use ontario diabet econom model chang factor eg hbac random control trial use estim costeffect cost implement develop mainten core dataset project diabetesrel complic includ base case assum year treatment effect discount rate year time horizon univari oneway sensit analys carri alter differ paramet valu perspect ontario ministri health cost canadian dollarsresult cost implement intervent oneyear intervent reduc hbac systol blood pressur mm hg increas bodi mass index kgm result relat risk reduct occurr amput model estim intervent result addit qualityadjust life year increment costeffect ratio per qualityadjust lifeyearconclus webbas prototyp decis support system slight improv shortterm risk factor model predict moder improv longterm health outcom diseas manag program will need develop consider effici term cost process improv effect consid costeffect intervent treat patient type diabet

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