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Economic Evaluation and Valuation of Interventions That Support Shared Decision-Making: The Case of Treatment for End-Stage Osteoarthritis
Encouraging shared decision-making (SDM) between patients and providers is a clear priority for health systems. However, there may be costs associated with providing interventions that support SDM. For example, beginning in 2018, the Centers for Medicare and Medicaid Services in the United States launched a SDM program which pays providers $50 to provide a decision aid to patients and have a dedicated SDM consultation. Two of the six conditions are hip and knee osteoarthritis (OA), where SDM can play an important role in helping patients decide whether to undergo total joint replacement. While the cost per patient is low, hip and knee OA are highly prevalent conditions, meaning that the potential investment may be significant. Economic evaluation can ensure that investments to support SDM are justified given resource constraints and competing priorities.
This presentation will explore issues related to the economic evaluation and valuation of interventions to support SDM in the context of treatment for end-stage OA. It will begin by exploring the cost-effectiveness of decision aids in this context, using data from a Canadian randomized controlled trial. It will then outline how conventional cost-effectiveness analysis, which focus on improvements in health outcomes, may underestimate the value of interventions that support SDM. Lastly, it will describe the results of a study which valued the process of SDM in a sample of Canadians.