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 cortico-steroids 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.