Cost-effectiveness of an electronic medical record based clinical decision support system

Health Serv Res. 2012 Dec;47(6):2137-58. doi: 10.1111/j.1475-6773.2012.01427.x. Epub 2012 May 11.

Abstract

Background and objective: Medical groups have invested billions of dollars in electronic medical records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system.

Data sources/setting: Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline.

Study design: The United Kingdom Prospective Diabetes Study Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality-adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective.

Principal findings: Patients in the intervention group had significantly lowered A1c (0.26 percent, p = .014) relative to patients in the control arm. Intervention costs were $120 (SE = 45) per patient in the first year and $76 (SE = 45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE = 0.01) and increased lifetime costs by $112 (SE = 660), resulting in an incremental cost-effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two-way, and probabilistic sensitivity analyses.

Conclusions: Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system.

Trial registration: ClinicalTrials.gov NCT00272402.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Computer Simulation
  • Cost-Benefit Analysis
  • Decision Support Systems, Clinical / economics*
  • Decision Support Systems, Clinical / organization & administration*
  • Diabetes Complications / economics
  • Diabetes Complications / prevention & control
  • Diabetes Mellitus / economics*
  • Diabetes Mellitus / therapy*
  • Electronic Health Records / economics*
  • Electronic Health Records / organization & administration*
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Expenditures
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Quality of Health Care / organization & administration
  • Quality-Adjusted Life Years
  • Randomized Controlled Trials as Topic

Substances

  • Glycated Hemoglobin A

Associated data

  • ClinicalTrials.gov/NCT00272402