Cost consequences of implementing an electronic decision support system for ordering laboratory tests in primary care: evidence from a controlled prospective study in the Netherlands.
BACKGROUND
The economic consequences of interventions to promote rational, evidence-based use of laboratory tests by physicians are not yet fully understood. We evaluated the cost consequences of a computer-based, guideline-driven decision-support system (CDSS) for ordering blood tests in primary care.


METHODS
We installed the CDSS in 118 practices [159 general practitioners (GPs)] throughout The Netherlands and calculated the costs of the intervention in this group. During a period of 6 months before and 6 months after installation of the CDSS, the test-ordering behavior of 87 (109 GPs) of these 118 study practices was studied and the results were compared with those of a nonhistorical control group that did not receive the CDSS. In addition the costs of laboratory requests were calculated for both groups.


RESULTS
Total intervention costs, comprising development costs and installation costs, amounted to 79,000 euro (670 euro per practice). Whereas the introduction of the CDSS did not affect the number of order forms submitted to the laboratories, it did reduce the number of blood tests per order form. As a result, the CDSS yielded mean savings on the costs of laboratory requests of 847 euro per practice per 6 months.


CONCLUSIONS
This study demonstrates that providing electronic decision support for ordering blood tests in primary care represents an economically promising concept. Savings on laboratory costs are achievable and not offset by disproportionally high intervention costs.
Poley
Marten J
MJ
Institute for Medical Technology Assessment (iMTA), Erasmus MC, Rotterdam, The Netherlands. m.poleij@erasmusmc.nl
Edelenbos
Kyra I
KI
Mosseveld
Mees
M
van Wijk
Marc A M
MA
de Bakker
Dinny H
DH
van der Lei
Johan
J
Rutten-van Mölken
Maureen P M H
MP
D000328:Adult; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence; D006403:Hematologic Tests / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007753:Laboratories; D008297:Male; D016347:Medical Records Systems, Computerized / Q000191:economics*; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies