Article Text

Original research
Does the use of patient decision aids lead to cost savings? a systematic review
  1. Peter Scalia1,
  2. Paul J Barr1,
  3. Ciaran O'Neill2,
  4. Grainne E Crealey3,
  5. Pamela J Bagley4,
  6. Heather B Blunt4,
  7. Glyn Elwyn1
  1. 1The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
  2. 2Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
  3. 3Clinical Costing Solutions, Belfast, UK
  4. 4Dartmouth College Biomedical Libraries, Hanover, New Hampshire, USA
  1. Correspondence to Dr Glyn Elwyn; glynelwyn{at}


Objectives To update a previous systematic review to determine if patient decision aid (PDA) interventions generate savings in healthcare settings, and if so, from which perspective (ie, patient, organisation providing care, society).

Design Systematic review.

Data sources MEDLINE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Embase, Campbell Collaboration Library, EconLit, Business Source Complete, Centre for Reviews and Dissemination: NHS Economic Evaluations Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA) from 15 March 2013 to 25 January 2019. The references of studies that met the eligibility criteria and any publications related to conference abstracts or registered clinical trials were reviewed to increase the sensitivity of the search.

Eligibility criteria Full and partial economic evaluations with an experimental, quasi-experimental or randomised controlled design were included. The intervention had to satisfy the pre-determined minimum conditions necessary to be defined as a PDA, and (for full evaluations) provide details on the comparator used.

Data extraction and synthesis All study outcomes and economic data were extracted. The reporting and quality of the economic analyses were independently assessed by two health economists.

Results Of 5066 studies, 22 studies were included, including the 8 studies from the previous review. Twelve studies reported cost-savings (range=US$10 to US$81 156; US dollars in 2020), primarily from the organisational or health system perspective, and 10 studies did not. However, due to the quality of the economic analyses, and the related issues with the interpretative validity of results it would be inappropriate to say that PDAs will generate savings, from any perspective.

Conclusions It is unclear whether PDAs will generate savings. Greater consensus on what constitutes a PDA and the need to compare them against usual care over a sufficient time horizon to allow valid assessment of costs and outcomes is required.

PROSPERO registration number CRD42019118457.

  • health economics
  • health policy
  • quality in health care

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  • Twitter @BarrPaulJ, @glynelwyn

  • Contributors PS, GEC and PJB developed the search strategy, and reviewed studies to determine if they met the inclusion criteria. PJB and HBB adapted the search for the selected databases and conducted the search. PS extracted data. CON and GE applied two checklists to rate the reporting and quality of the economic data included in each study. All authors contributed to the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GE has edited and published books that provide royalties on sales by the publishers: the books include Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). He has in the past provided consultancy for organisations including (1) Emmi Solutions LLC who developed patient decision support tools; (2) National Quality Forum on the certification of decision support tools; (3) Washington State Health Department on the certification of decision support tools; and (4) SCiMentu LLC, Amsterdam (workshops for shared decision making). He is the Founder and Director of &think LLC which owns the registered trademark for Option Grids TM patient decision aids. Founder and director of SHARPNetwork LLC, a provider of training for shared decision making. He provides advice in the domain of shared decision making and patient decision aids to (1) Access Community Health Network, Chicago Federally Qualified Medical Centers; (2) EBSCO Health Option Grids TM patient decision aids; (3) Bind Insurance; (4) PatientWisdom Inc; and (5) abridge AI Inc. GE academic interests are focussed on shared decision making and coproduction. He owns copyright in measures of shared decision making and care integration namely collaboRATE, integRATE, consideRATE, coopeRATE, toleRATE, Observer OPTION-5 and Observer OPTION-12.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. No additional data are available. The manuscript’s guarantor (GE) affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.