Physician Awareness of Drug Cost: A Systematic Review

Abstract

BackgroundPharmaceutical costs are the fastest-growing health-care expense in most developed countries. Higher drug costs have been shown to negatively impact patient outcomes. Studies suggest that doctors have a poor understanding of pharmaceutical costs, but the data are variable and there is no consistent pattern in awareness. We designed this systematic review to investigate doctors' knowledge of the relative and absolute costs of medications and to determine the factors that influence awareness.Methods and FindingsOur search strategy included The Cochrane Library, EconoLit, EMBASE, and MEDLINE as well as reference lists and contact with authors who had published two or more articles on the topic or who had published within 10 y of the commencement of our review. Studies were included if: either doctors, trainees (interns or residents), or medical students were surveyed; there were more than ten survey respondents; cost of pharmaceuticals was estimated; results were expressed quantitatively; there was a clear description of how authors defined “accurate estimates”; and there was a description of how the true cost was determined. Two authors reviewed each article for eligibility and extracted data independently. Cost accuracy outcomes were summarized, but data were not combined in meta-analysis because of extensive heterogeneity. Qualitative data related to physicians and drug costs were also extracted. The final analysis included 24 articles. Cost accuracy was low; 31% of estimates were within 20% or 25% of the true cost, and fewer than 50% were accurate by any definition of cost accuracy. Methodological weaknesses were common, and studies of low methodological quality showed better cost awareness. The most important factor influencing the pattern and accuracy of estimation was the true cost of therapy. High-cost drugs were estimated more accurately than inexpensive ones (74% versus 31%, Chi-square p < 0.001). Doctors consistently overestimated the cost of inexpensive products and underestimated the cost of expensive ones (binomial test, 89/101, p < 0.001). When asked, doctors indicated that they want cost information and feel it would improve their prescribing but that it is not accessible.ConclusionsDoctors' ignorance of costs, combined with their tendency to underestimate the price of expensive drugs and overestimate the price of inexpensive ones, demonstrate a lack of appreciation of the large difference in cost between inexpensive and expensive drugs. This discrepancy in turn could have profound implications for overall drug expenditures. Much more focus is required in the education of physicians about costs and the access to cost information. Future research should focus on the accessibility and reliability of medical cost information and whether the provision of this information is used by doctors and makes a difference to physician prescribing. Additionally, future work should strive for higher methodological standards to avoid the biases we found in the current literature, including attention to the ...

Should cost considerations be included in medical decisions? Not so sure…

“…Hernu et al [3] report results similar to those found in other European countries [4,5]. They also present two clinical situations (septic and haemorrhagic shock) showing how relevant the differences can be between estimated and true costs at ICU, regional, and national level.The lack of any improvement in physicians' awareness of the costs of drugs over time [2,3] agrees with the slow and continuous decrease in the percentage of articles in …”

“…The lack of any improvement in physicians' awareness of the costs of drugs over time [2,3] agrees with the slow and continuous decrease in the percentage of articles in…”

“…Difficult because clinicians often have neither the training nor the knowledge to base such decisions upon, but also because it forces controversial ethical discussions to be had, sometimes with perverse consequences. However, to contain the costs of care, physicians need to know the costs and indications of each of the investigations/drugs that they order.Unfortunately, physicians' awareness of the cost of drug prescriptions (or investigations) is generally very poor [2]. A systematic review of 24 articles, the latest being published in 2005, showed an accuracy in cost estimation of 29 % for the articles with the highest quality and of 38 % for those with lowest [2].…”

“…Unfortunately, physicians' awareness of the cost of drug prescriptions (or investigations) is generally very poor [2]. A systematic review of 24 articles, the latest being published in 2005, showed an accuracy in cost estimation of 29 % for the articles with the highest quality and of 38 % for those with lowest [2].…”

“…A systematic review of 24 articles, the latest being published in 2005, showed an accuracy in cost estimation of 29 % for the articles with the highest quality and of 38 % for those with lowest [2]. A recent multicentre French study published in Intensive Care Medicine by Hernu et al [3] compared the costs of drugs, blood products, imaging modalities and laboratory tests estimated by a wide sample of ICU physicians with the true costs.…”