U.S. Internists' Perspectives on Discussing Cost of Care With Patients: Structured Interviews and a Survey

Perez, Susan; Weissman, Arlene; Read, Susan; Smith, Cynthia D.; Colello, Lisa; Peter, Doris; Nickel, Wendy

doi:10.7326/m18-2136

Cited by 28 publications

(24 citation statements)

References 13 publications

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“…4 Physicians may be aware that cost coping occurs; however, they may not have cost conversations with patients even when indicated. 2,5,6 We compared cost coping behaviors and cost conversations among individuals with and without diabetes who have multiple chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

Cost-Related Medication Non-adherence, Cost Coping Behaviors, and Cost Conversations Among Individuals with and Without Diabetes

Herrick

Humble

Hollar³

et al. 2020

J GEN INTERN MED

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Section: Introductionmentioning

confidence: 99%

Cost-Related Medication Non-adherence, Cost Coping Behaviors, and Cost Conversations Among Individuals with and Without Diabetes

Herrick

Humble

Hollar³

et al. 2020

J GEN INTERN MED

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“…At a policy level, IBS prescription drug coverage remains just as necessary in the appropriate management of IBS as in other chronic medical conditions. 25 Our findings suggest that dietary and behavioral interventions may appear more cost-effective despite similar clinical effectiveness, a finding largely driven by prescription drug prices. In other words, efforts to address IBS prescription drug prices at a policy level would directly improve treatment satisfaction and adherence, [26][27][28] recognizing that prior authorization restrictions and other insurance barriers directly cause over 1/3 of treatment discontinuations among IBS-C patients who are able to successfully start prescription drug therapy.…”

Section: Discussionmentioning

confidence: 75%

“…Appendix Figures 10 to 38 detail the influence of specific model inputs on cost-effectiveness outcomes when comparing two competing IBS-C therapies, from payer perspectives (Appendix Figures 10-23) and patient perspectives (Appendix Figure [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. All analyses assessed whether differences in health utility gains with therapy, as well as responder and discontinuation rates would influence treatment preferences based on cost-effectiveness compared to our base-case findings.…”

Section: Specific Factors Influencing Relative Cost-effectivenessmentioning

confidence: 99%

Pharmacologic, Dietary, and Psychological Treatments for Irritable Bowel Syndrome With Constipation: Cost Utility Analysis

Shah

Salwen‐Deremer

Muir

et al. 2021

MDM Policy & Practice

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Introduction. Irritable bowel syndrome (IBS) is the most common gastroenterology referral and one of the most common gastrointestinal complaints in primary care. We performed a cost-utility analysis of the most common treatments available in general practice for IBS with constipation (IBS-C), the most expensive IBS subtype. Methods. We developed a decision analytic model evaluating guideline-recommended and Food and Drug Administration–approved drugs, supplements, and dietary/psychological interventions. Model inputs were derived from “global symptom improvement” outcomes in systematic reviews of clinical trials. Costs were derived from national datasets. Analysis was performed with a 1-year time horizon from patient and payer perspectives. We analyzed a prototypical managed-care health plan with no cost-sharing to the patient. Results. From a payer perspective, global IBS treatments (including low FODMAP, cognitive behavioral therapy [CBT], neuromodulators), which are not specific to the IBS-C bowel subtype were less expensive than on-label prescription drug treatments. From a patient perspective, on-label prescription drug treatment with linaclotide was the least expensive treatment strategy. Drug prices and costs to manage untreated IBS-C were most important determinants of payer treatment preferences. Effects of treatment on missed work-days and need for repeated appointments to complete treatment were the most important determinants of treatment preference to patients. Discussion. Due mostly to prescription drug prices, neuromodulators, low FODMAP, and CBT appear cost-effective compared to on-label drug treatments from a payer perspective in cost-utility analysis. These findings may explain common treatment barriers in clinical practice.

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“…Our previous survey found that 13% of participants considered cost as a very important variable when deciding between medical options. We included this variable in this initial TNOC prototype, given literature supporting cost as a variable of interest in medical decision making 4,27,28 . Field testing suggested limited value of cost when deciding between diagnostic options, as it rarely led to any significant conversation.…”

Section: Discussionmentioning

confidence: 99%

Development and pilot testing of a conversation aid to support the evaluation of patients with thyroid nodules

Ospina

Bagautdinova

Hargraves

et al. 2021

Clinical Endocrinology

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Objective To support patient‐centred care and the collaboration of patients and clinicians, we developed and pilot tested a conversation aid for patients with thyroid nodules. Design, Patient and Measurements We developed a web‐based Thyroid NOdule Conversation aid (TNOC) following a human‐centred design. A proof of concept observational pre–post study was conducted (TNOC vs. usual care [UC]) to assess the impact of TNOC on the quality of conversations. Data sources included recordings of clinical visits, post‐encounter surveys and review of electronic health records. Summary statistics and group comparisons are reported. Results Sixty‐five patients were analysed (32 in the UC and 33 in the TNOC cohort). Most patients were women (89%) with a median age of 57 years and were incidentally found to have a thyroid nodule (62%). Most thyroid nodules were at low risk for thyroid cancer (71%) and the median size was 1.4 cm. At baseline, the groups were similar except for higher numeracy in the TNOC cohort. The use of TNOC was associated with increased involvement of patients in the decision‐making process, clinician satisfaction and discussion of relevant topics for decision making. In addition, decreased decisional conflict and fewer thyroid biopsies as the next management step were noted in the TNOC cohort. No differences in terms of knowledge transfer, length of consultation, thyroid cancer risk perception or concern for thyroid cancer diagnosis were found. Conclusion In this pilot observational study, using TNOC in clinical practice was feasible and seemed to help the collaboration of patients and clinicians.

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U.S. Internists' Perspectives on Discussing Cost of Care With Patients: Structured Interviews and a Survey

Cited by 28 publications

References 13 publications

Cost-Related Medication Non-adherence, Cost Coping Behaviors, and Cost Conversations Among Individuals with and Without Diabetes

Cost-Related Medication Non-adherence, Cost Coping Behaviors, and Cost Conversations Among Individuals with and Without Diabetes

Pharmacologic, Dietary, and Psychological Treatments for Irritable Bowel Syndrome With Constipation: Cost Utility Analysis

Development and pilot testing of a conversation aid to support the evaluation of patients with thyroid nodules

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