JAMIA: Clinical decision support systems are not cost-effective
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The report, published Nov. 3 by the Journal of the American Medical Informatics Association, was authored by Daria O’Reilly, MD, who is affiliated with McMaster University’s department of clinical epidemiology and Biostatistics and with St. Joseph’s Healthcare Hamilton’s PATH Research Institute, and colleagues.
Researchers acknowledged that CDSSs have the potential to improve diabetes patients’ quality of care by providing updated evidence-based treatment guidelines and improving communication with patients, but declared that insufficient research had been conducted to determine whether or not CDSSs are a financially viable component of treatment.
“The lack of cost-effectiveness studies published in the literature is surprising given that well developed methods exist that have the ability to model the progression of diabetes and the lifetime costs and outcomes associated with different disease management strategies,” the authors wrote.
Researchers performed a cost-effectiveness analysis based on information collected from the Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness II (COMPETE II), a web-based CDSS that continuously collected patient-specific data from 47 primary care practices in Ontario. The CDSS was implemented to provide evidence-based treatment recommendations for type II diabetes patients over the course of a one-year intervention.
COMPETE II formed up-to-date patient profiles that could be accessed via web portal by both patients and providers. COMPETE II automatically provided patients with important reminders and providers with treatment recommendations based on the most current evidence-based information available.
Upon completion, patients enrolled in the program experienced a relative risk reduction in the occurrence of amputation by 14 percent, stroke by 12 percent, renal failure by 9 percent and heart failure by 5 percent.
The one-year intervention also reduced HbA1c by 0.2, systolic blood pressure by 3.95 mm Hg, and the research model estimated that the intervention would result in an increase of 0.0117 quality-adjusted life years.
Researchers found that the CDSS, which cost $483,699 to develop and implement, slightly improved short-term risk factors and would result in moderate health improvements in the long-term, but estimated that the system cost $160,845 per quality-adjusted life-year.
The authors determined that the prototype CDSS used in their study would need to cost less or deliver better results to be considered a cost-effective method for treating type II diabetes patients, but that a future system might be a financially viable option.
“While this first version of the COMPETE II diabetes CDSS is not cost-effective,” the authors wrote, “future iterations should benefit from the efficiency of experience and improved implementation for better effectiveness.”
The authors also added that the implementation of a CDSS on a larger scale over a longer intervention period could prove to be more cost-effective.