Physician Awareness of Drug Cost: A Systematic Review
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{"title"=>"Physician awareness of drug cost: A systematic review", "type"=>"generic", "authors"=>[{"first_name"=>"G. Michael", "last_name"=>"Allan", "scopus_author_id"=>"8051692300"}, {"first_name"=>"Joel", "last_name"=>"Lexchin", "scopus_author_id"=>"7006505283"}, {"first_name"=>"Natasha", "last_name"=>"Wiebe", "scopus_author_id"=>"6602364843"}], "year"=>2007, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491277", "scopus"=>"2-s2.0-34848840928", "pui"=>"47503041", "doi"=>"10.1371/journal.pmed.0040283", "isbn"=>"1549-1676", "sgr"=>"34848840928", "pmid"=>"17896856"}, "id"=>"60e79603-f7c4-349c-96e5-da56be56de12", "abstract"=>"BACKGROUND: Pharmaceutical 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 FINDINGS: Our 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. CONCLUSIONS: Doctors' 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 method of assessing accuracy that allows larger absolute estimation ranges for expensive drugs.", "link"=>"http://www.mendeley.com/research/physician-awareness-drug-cost-systematic-review", "reader_count"=>125, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>5, "Librarian"=>4, "Student > Doctoral Student"=>7, "Researcher"=>19, "Student > Ph. D. Student"=>13, "Student > Postgraduate"=>15, "Student > Master"=>20, "Other"=>15, "Student > Bachelor"=>10, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>3, "Professor"=>8}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>5, "Librarian"=>4, "Student > Doctoral Student"=>7, "Researcher"=>19, "Student > Ph. D. Student"=>13, "Student > Postgraduate"=>15, "Student > Master"=>20, "Other"=>15, "Student > Bachelor"=>10, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>3, "Professor"=>8}, "reader_count_by_subject_area"=>{"Unspecified"=>12, "Agricultural and Biological Sciences"=>7, "Arts and Humanities"=>1, "Philosophy"=>1, "Business, Management and Accounting"=>1, "Computer Science"=>1, "Economics, Econometrics and Finance"=>4, "Nursing and Health Professions"=>1, "Biochemistry, Genetics and Molecular Biology"=>2, "Mathematics"=>1, "Medicine and Dentistry"=>76, "Pharmacology, Toxicology and Pharmaceutical Science"=>6, "Psychology"=>3, "Social Sciences"=>8, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>76}, "Social Sciences"=>{"Social Sciences"=>8}, "Psychology"=>{"Psychology"=>3}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>12}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>6}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>4}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>7}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}, "Philosophy"=>{"Philosophy"=>1}}, "reader_count_by_country"=>{"New Zealand"=>1, "Canada"=>1, "Sweden"=>1, "United States"=>5, "Ireland"=>1, "United Kingdom"=>3, "Australia"=>1, "Switzerland"=>1}, "group_count"=>7}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/944434"], "description"=>"<p>Comparison of estimation accuracy (within 20% or 25% margin of error) of the same drug among different studies.</p>", "links"=>[], "tags"=>["pharmacology", "public health and epidemiology"], "article_id"=>614822, "categories"=>["Biotechnology", "Pharmacology"], "users"=>["G. Michael Allan", "Joel Lexchin", "Natasha Wiebe"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.0040283.g002", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_of_Accuracy_for_Similar_Drugs_/614822", "title"=>"Comparison of Accuracy for Similar Drugs", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2007-09-25 01:20:22"}
  • {"files"=>["https://ndownloader.figshare.com/files/465808", "https://ndownloader.figshare.com/files/465890", "https://ndownloader.figshare.com/files/465944"], "description"=>"<div><h3>Background</h3><p>Pharmaceutical 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.</p> <h3>Methods and Findings</h3><p>Our 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 <em>p</em> < 0.001). Doctors consistently overestimated the cost of inexpensive products and underestimated the cost of expensive ones (binomial test, 89/101, <em>p</em> < 0.001). When asked, doctors indicated that they want cost information and feel it would improve their prescribing but that it is not accessible.</p> <h3>Conclusions</h3><p>Doctors' 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 method of assessing accuracy that allows larger absolute estimation ranges for expensive drugs.</p> </div>", "links"=>[], "tags"=>["systematic"], "article_id"=>151826, "categories"=>["Biotechnology", "Pharmacology"], "users"=>["G. Michael Allan", "Joel Lexchin", "Natasha Wiebe"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.0040283.sd001", "https://dx.doi.org/10.1371/journal.pmed.0040283.st001", "https://dx.doi.org/10.1371/journal.pmed.0040283.st002"], "stats"=>{"downloads"=>14, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Physician_Awareness_of_Drug_Cost_A_Systematic_Review/151826", "title"=>"Physician Awareness of Drug Cost: A Systematic Review", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2007-09-25 00:30:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/944361"], "description"=>"<p>Study Identification and Selection Process</p>", "links"=>[], "tags"=>["pharmacology", "public health and epidemiology"], "article_id"=>614751, "categories"=>["Biotechnology", "Pharmacology"], "users"=>["G. Michael Allan", "Joel Lexchin", "Natasha Wiebe"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.0040283.g001", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_Identification_and_Selection_Process_/614751", "title"=>"Study Identification and Selection Process", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2007-09-25 01:19:11"}

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Relative Metric

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