title: Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review.
abstract: OBJECTIVE
  This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSSs) to prevent cardiovascular disease (CVD).
  
  
  METHODS
  Methods developed for the Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion.
  
  
  RESULTS
  It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSSs to prevent CVD from the available studies ( n  = 12) due to considerable heterogeneity. Several studies ( n  = 11) indicated that health care costs were averted by using CDSSs but many were partial assessments that did not consider all components of health care. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSSs based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold.
  
  
  CONCLUSIONS
  Intervention costs were not negligible, but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted health care cost could not be determined with confidence because many studies did not fully account for all components of health care.
  
  
  CONCLUSIONS
  We were unable to conclude whether CDSSs for CVD prevention is either cost-beneficial or cost-effective. Several evidence gaps are identified, most prominently a lack of information about major drivers of cost and benefit, a lack of standard metrics for the cost of CDSSs, and not allowing for useful life of a CDSS that generally extends beyond one accounting period.
authors.affiliation: Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Verughese
authors.initials: V
authors.lastname: Jacob
authors.affiliation: Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Anilkrishna B
authors.initials: AB
authors.lastname: Thota
authors.affiliation: Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sajal K
authors.initials: SK
authors.lastname: Chattopadhyay
authors.affiliation: Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Gibril J
authors.initials: GJ
authors.lastname: Njie
authors.affiliation: Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Krista K
authors.initials: KK
authors.lastname: Proia
authors.affiliation: Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Hopkins
authors.affiliation: Kaiser Institute for Health Policy, Oakland, CA, USA.
authors.forename: Murray N
authors.initials: MN
authors.lastname: Ross
authors.affiliation: Health Management Division, HealthPartners Research Foundation, Minneapolis, MN, USA.
authors.forename: Nicolaas P
authors.initials: NP
authors.lastname: Pronk
authors.affiliation: National Forum for Heart Disease and Stroke Prevention, Washington, DC, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Clymer
mesh_terms: D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics*; D017048:Health Care Costs; D006801:Humans
keywords: Decision support systems; clinical; economics; economics; medical