Clinical question: Does cost messaging at the time of ordering reduce prescriber use of high-cost medications?
Background: Overprescribing expensive medications contributes to inpatient health care expenditures and may be avoidable when low-cost alternatives are available.
Dr. Bryan Lublin
Study design: Retrospective, observational analysis of a quality improvement project.
Setting: Single center, 1,145-bed, tertiary-care academic medical center.
Synopsis: Nine medications were chosen by committee to be targeted for intervention: intravenous voriconazole, IV levetiracetam, IV levothyroxine, IV linezolid, IV eculizumab, IV pantoprazole, IV calcitonin, inhaled ribavirin, and IV mycophenolate. The costs for these nine medications plus lower-cost alternatives were displayed for providers in the order entry system after about 2 years of baseline data had been collected. There was no change in the number of orders or ordering trends for eight of the nine high-cost medications after the intervention. Only ribavirin was ordered less after cost messaging was implemented (16.3 fewer orders per 10,000 patient-days). Lower IV pantoprazole use (73% reduction), correlated with a national shortage unrelated to the study intervention, a potential confounder. Data on dosing frequency and duration were not collected.
Bottom line: Displaying medication costs and alternatives did not alter the use of these nine high-cost medications.
Citation: Conway SJ et al. Impact of displaying inpatient pharmaceutical costs at the time of order entry: Lessons from a tertiary care center. J Hosp Med. 2017 Aug;12(8):639-45.
Dr. Lublin is a hospitalist at the University of Colorado School of Medicine.