title: Cost-effectiveness of a shared computerized decision support system for diabetes linked to electronic medical records.
abstract: BACKGROUND
  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/m², 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.
  
  
  CONCLUSIONS
  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.
authors: Programs for Assessment of Technology in Health-PATH Research Institute-St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. oreilld@mcmaster.ca
authors: Daria
authors: D
authors: O'Reilly
authors: Anne
authors: A
authors: Holbrook
authors: Gordon
authors: G
authors: Blackhouse
authors: Sue
authors: S
authors: Troyan
authors: Ron
authors: R
authors: Goeree
mesh_terms: D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy*; D057286:Electronic Health Records / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D055991:Health Records, Personal / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009864:Ontario; D011320:Primary Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D017010:Reminder Systems