Jacob Verughese, Thota Anilkrishna B, Chattopadhyay Sajal K, Njie Gibril J, Proia Krista K, Hopkins David P, Ross Murray N, Pronk Nicolaas P, Clymer John M
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.
Kaiser Institute for Health Policy, Oakland, CA, USA.
J Am Med Inform Assoc. 2017 May 1;24(3):669-676. doi: 10.1093/jamia/ocw160.
This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSSs) to prevent cardiovascular disease (CVD).
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.
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.
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.
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.
本综述评估获取、实施和运行临床决策支持系统（CDSS）以预防心血管疾病（CVD）的成本和效益。
采用为《社区指南》制定的方法，对1976年1月至2015年10月期间的CDSS文献进行综述。确定了21项研究纳入。
由于存在相当大的异质性，很难从现有研究（n = 12）中得出关于获取和运行CDSS以预防CVD的成本的有意义估计。几项研究（n = 11）表明，使用CDSS可避免医疗保健成本，但许多是部分评估，未考虑医疗保健的所有组成部分。四项成本效益研究基于对成本和效益的不完整评估，对CDSS的净效益得出了相互矛盾的结论。三项成本效用研究基于50,000美元的保守阈值，对成本效益得出了不一致的结论。
干预成本不可忽略，但由于实施和报告指标的异质性，未得出具体估计值。由于许多研究未充分考虑医疗保健的所有组成部分，无法确定避免医疗保健成本带来的预期经济效益。
我们无法得出用于预防CVD的CDSS是否具有成本效益或成本效果的结论。确定了几个证据缺口，最突出的是缺乏关于成本和效益主要驱动因素的信息、缺乏CDSS成本的标准指标，以及未考虑CDSS的使用寿命通常超出一个会计期间。
