Cost-effectiveness of an electronic medical record based clinical decision support system
Open accessAbstract
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.
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Full economic evaluations integrating three mHealth technologies reported QALY gained values equivalent to 47.2% and 62.5% of their respective countries' GDP per capita.
“Those that integrated three mHealth technologies reported QALY gained values of equivalent to 47.2% and 62.5% of their respective countries' GDP per capita [39,40].”
From Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: A systematic review (2020) · cites this paper as [39]
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- Authors
- Gilmer, T. P., O'Connor, P. J., Sperl‐Hillen, J. M., Rush, W. A., Johnson, P. E., Amundson, G. H., Asche, S. E., & Ekstrom, H. L.
- Affiliations
- Health Partners Research Foundation Bloomington MN
- University of Minnesota (US)
- Corresponding author
- Gilmer, Todd P.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2012-05-11
- Volume
- 47
- Issue
- 6
- Pages
- 2137-2158
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC3459233
- OpenAlex
- W2063517554
- Cited by
- 73
- References
- 54
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 2 · 2023: 3 · 2022: 11 · 2021: 4 · 2020: 8 · 2019: 6 · 2018: 4 · 2017: 4 · 2016: 7 · 2015: 8 · 2014: 3 · 2013: 3 · 2012: 1
- FWCI
- 7.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Services Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK068314, R01DK068314)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Keywords
- electronic health records, clinical decision support, cost-effectiveness, diabetes mellitus, glycemic control, HbA1c, quality-adjusted life years, health care costs, quality of care
- MeSH terms
- Aged, Computer Simulation, Cost-Benefit Analysis, Diabetes Mellitus, Health Expenditures, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Quality of Health Care, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Quality-Adjusted Life Years, Decision Support Systems, Clinical, Diabetes Complications, Electronic Health Records
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