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

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