Students and Doctors are Unaware of the Cost of Drugs they Frequently Prescribe

Abstract

Given the increasing healthcare costs of an ageing population, there is growing interest in rational prescribing, which takes costs of medication into account. We aimed to gain insight into the attitude to and knowledge of medication costs of medical students and doctors in daily practice. This was a cross-sectional electronic survey among medical students (bachelor/master) and doctors (consultants/registrars). Attitude to costs was evaluated using a cost-consciousness scale. In open questions, the participants estimated the cost of commonly prescribed (generic/non-generic) drugs (including separate pharmacy dispensing costs). They were asked where they could find information about drug costs. Overall, a reasonable cost-consciousness was found. Students were less conscious of the cost than were doctors (15.56 SD 3.25 versus 17.81 SD 2.25; scale 0-24; p = 0.001). In contrast to this consciousness, actual estimated drug costs were within a 25% margin for only 5.4% of generic and 13.7% of proprietary drugs (Wilcoxon signed-rank, p < 0.001). The price of generic drugs was frequently overestimated (77.5%) and that of proprietary drugs was underestimated (51.4%). The dispensing costs were estimated correctly for 30% of the drugs. Most doctors (84%) and a minority of students (40%) were able to identify at least one source of information about drug costs. While doctors and students considered it important to be aware of the cost of drugs, this attitude is not reflected in their ability to estimate the cost of frequently prescribed drugs. Cost awareness is important in therapeutic reasoning and cost-effective prescribing. Both should be better addressed in (undergraduate) pharmacotherapy education.Approximately €200 billion is spent on medicines and drugs annually, about 16-17% of the total healthcare expenditure in the EU [1]. These costs must be controlled to keep health care affordable, especially in today's ageing society with its increased care consumption [2]. Besides the importance of pharmacoeconomics to society in general, it is becoming increasingly important for hospitals, doctors and individual patients. Depending on the country and type of medical insurance, patients have to pay certain costs (i.e. deductible excess in the Netherlands) [3], and doctors and hospitals are under pressure from health insurance companies and governmental institutions to take medication costs into consideration, for instance, by prescribing generic rather than proprietary drugs [4]. The drive to contain costs is focused not only on therapeutics, but also on reducing, often unnecessary, diagnostics. In this diagnostic field, studies have shown that doctors who are aware of test costs order fewer tests [5,6].Rational prescribing includes comparing the efficacy, safety, suitability and cost of treatment options, according to the WHO guide to good prescribing [7]. The WHO guide to good prescribing and the associated six-step guideline are internationally used to teach pharmacotherapy to future prescribers [8]. Currently, ph...

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