Clinical and Cost-Effectiveness of Shared Decision Making: Evidence from a Prospective Multicenter Study Evaluating a Hospital-Based Intervention in Germany

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Objective To evaluate the clinical and cost-effectiveness of SHARE TO CARE (S2C), a complex intervention for hospital-wide, systematic implementation of shared decision making. Methods We analyzed clinical effectiveness, health care resource utilization, and implementation costs of S2C from the statutory health insurance perspective using a quasi-experimental difference-in-differences approach with evidence from the Department of Neurology. Clinical outcomes included inpatient hospital admissions, emergency department admissions, and rates of standard and advanced imaging procedures. Implementation costs comprised those related to the conception, development, process integration, ongoing support, and auditing of S2C. Health care utilization data covered inpatient and outpatient care, pharmaceuticals, therapeutic services, assistive devices, and nursing care. We conducted sensitivity analyses to account for uncertainties. Findings S2C was associated with a reduction in inpatient hospital admissions, emergency department admissions, and imaging rates in the intervention group. The cost analyses aligned with these findings, showing reduced total costs and health care resource utilization in the intervention group. Although none of the estimates reached the predefined thresholds for statistical significance, the primary analysis yielded weak evidence ( P < 0.1) of a reduction in emergency department admissions in the intervention group. Overall, savings outweighed the costs of implementing S2C, suggesting cost-effectiveness. Conclusions S2C has the potential to reduce emergency department admissions and overall health care costs from the statutory health insurance perspective. Further research should investigate generalizability, the timing of the treatment effect, and potential biases introduced by the COVID-19 pandemic. The demonstrated effects of shared decision making (SDM) have encouraged statutory health insurances in Germany to offer additional reimbursement for clinics certified under the S2C program. The S2C model illustrates how payers and providers can collaborate to facilitate the nationwide implementation of SDM. Highlights The implementation of SHARE TO CARE (S2C) was associated with a statistically nonsignificant reduction in emergency department admissions after 1 y from the statutory health insurance perspective, based on data from the Department of Neurology. The cost savings from reduced health care utilization outweighed the implementation costs, and despite not reaching statistical significance, the results support the potential cost-effectiveness of S2C. S2C has the potential for nationwide implementation as a systematic form of shared decision making. Future research should investigate the generalizability of the results to other health care settings.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.