title: A framework for evaluating the cost-effectiveness of patient decision aids: A case study using colorectal cancer screening.
abstract: OBJECTIVE
  Patient decision aids are important tools for facilitating balanced, evidence-based decision making. However, the potential of decision aids to lower health care utilization and costs is uncertain; few studies have investigated the cost-effectiveness of decision aids that change patient behavior. Using an example of a decision aid for colorectal cancer screening, we provide a framework for analyzing the cost-effectiveness of decision aids.
  
  
  METHODS
  A decision-analytic model with two strategies (decision aid or no decision aid) was used to calculate expected costs in U.S. dollars and benefits measured in life-years saved (LYS). Data from a systematic review of ten studies about decision aid effectiveness was used to calculate the percentage increase in the number of people choosing screening instead of no screening. We then calculated the incremental cost per LYS with the use of the decision aid.
  
  
  RESULTS
  The no decision aid strategy had an expected cost of $3023 and yielded 18.19 LYS. The decision aid strategy cost $3249 and yielded 18.20 LYS. The incremental cost-effectiveness ratio for the decision aid strategy was $36,126 per LYS. Results were sensitive to the cost of the decision aid and the percentage change in behavior caused by the decision aid.
  
  
  CONCLUSIONS
  This study provides proof-of-concept evidence for future studies examining the cost-effectiveness of decision aids. The results suggest that decision aids can be beneficial and cost-effective.
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: sbcantor@mdanderson.org.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Rajan
authors.affiliation: Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Linder
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Volk
mesh_terms: D015179:Colorectal Neoplasms / Q000517:prevention & control; D003362:Cost-Benefit Analysis / Q000379:methods*; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D014481:United States
keywords: Colorectal cancer; Cost and cost analysis; Decision making; Patient decision aids; Screening