title: The cost-effectiveness of patient decision aids: A systematic review.
abstract: The Affordable Care Act includes provisions to encourage patient-centered care through the use of shared decision making (SDM) and patient decision aids (PtDA). PtDAs are tools that can help encourage SDM by providing information about competing treatment options and elucidating patients׳ values and preferences. Implementing PtDAs into routine practice may incur additional costs through training or increases in physician time. Prominent commentaries have proposed that these costs might be offset if patients choose less expensive options than their providers. However, the cost-effectiveness of PtDAs to date is unclear. The aim of this study was to review the economic evidence from PtDA trials. Our search identified 5347 articles, with 29 included following full-text review. Only one economic evaluation of a PtDA has been completed, which found a PtDA to be cost-saving in women with menorrhagia. Other studies included in the review indicated that PtDAs will likely increase up-front costs, but in some contexts may reduce short-term costs by reducing the uptake of invasive treatments, such as elective surgery. Few studies comprehensively captured long-term costs or measured benefits in a manner conducive to economic evaluation (QALYs or general health utilities). Our review suggests that policy makers currently have insufficient economic evidence to appropriately consider their investments in PtDAs.
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, Canada V5Z 1M9; Centre for Health Evaluation and Outcome Sciences, St. Paul׳s Hospital, 588-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
authors.forename: Logan
authors.initials: L
authors.lastname: Trenaman
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, Canada V5Z 1M9.
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, Canada V5Z 1M9; Centre for Health Evaluation and Outcome Sciences, St. Paul׳s Hospital, 588-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Electronic address: Nick.Bansback@ubc.ca.
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
keywords: Affordable care act; Decision aid; Economic evaluation; Shared decision making