An evaluation of a price transparency intervention for two commonly prescribed medications on total institutional expenditure: a prospective study

Abstract

Providing feedback on cost has been demonstrated to decrease drug demand from clinicians. We conducted a prospective study with a step-wise intervention to test the hypothesis that providing information on the cost of drugs to clinicians would modify total expenditure. Participants included individuals who were admitted to the Royal Derby Hospital from November 2013 to November 2015 under the care of physicians. The cost of all antibiotics and inhaled corticosteroids was added to the electronic prescribing system. The main outcome was the weekly cost for antibiotics and inhaled corticosteroids in the intervention period compared to baseline costs. Mean weekly expenditure on antibiotics per patient decreased by £3.75 (95% confi dence intervals [CI] -6.52 to -0.98) after the intervention from a pre-intervention mean of £26.44, and then slowly increased subsequently by £0.10/week (95% CI +0.02 to +0.18). Mean weekly expenditure on inhaled corticosteroids per patient did not substantially change after the intervention (-£0.03, 95% CI -0.06 to -0.01 after the intervention from a pre-intervention mean of £5.29 per person). New clinical guidelines for inhaled corticosteroids were associated with a decrease in weekly expenditure, but provision of feedback on drug costs resulted in no sustained change in institutional expenditure. However, clinical guidelines have the potential to modify clinical prescribing behaviour.

The effectiveness of behavioral economics-informed interventions on physician behavioral change: A systematic literature review

“…Price transparency feedback [41] Patient deceased letter [42] Price transparency feedback [41] Provide Social Reference Point Peer comparison [37,43] Social norm feedback [44] Peer comparison [35,38,39] Social comparison [45] Change Choice Defaults Active choice [39] Default [40,46] Order set [47] Order set [48] Active choice [49,50] Change Option Related Effort Accountable justification [37,43] Change Range Suggested Alternatives [37,43] Facilitate Commitment Commitment poster [34,51] Precommitment [51] https://doi.org/10.1371/journal.pone.0234149.t004…”

“…We identified two studies [41,42,53] that aimed to bring often invisible behavioral consequences to the attention of decision makers through feedback provision (Table 4). Study quality was rated as moderate [42], and weak [41] (Table 5). Providing feedback to change physician behavior is an extensively researched field [54].…”

Evaluation of a nudge intervention providing simple feedback to clinicians of the consequence of radiation exposure on demand for computed tomography: a controlled study

“…As a consequence, feeding back an educational message on the longer-term health effects of exposure to ionising radiation was the only viable intervention in this context, although point-of-care interventions can be implemented for other healthcare interventions, and have been effective in increasing prescribing of cheaper antibiotics when the price was presented at the point of antibiotics selection. 12 Unanswered questions and future research…”

Does cost feedback modify demand for common blood tests in secondary care? A prospective controlled intervention study

“…5 Similarly, making the cost of medication available to prescribing doctors resulted in an increase in selection of more economical antibiotic options. 6 We tested the hypothesis that adding the cost of three commonly used blood tests, full blood count (FBC), urea and electrolytes (U&E) and liver function tests (LFTs) would modify demand in a prospective controlled intervention study based in a busy teaching hospital in the UK.…”