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Fabes J, Avşar TS, Spiro J, Fernandez T, Eilers H, Evans S, Hessheimer A, Lorgelly P, Spiro M. Information Asymmetry in Hospitals: Evidence of the Lack of Cost Awareness in Clinicians. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:693-706. [PMID: 35606636 PMCID: PMC9126693 DOI: 10.1007/s40258-022-00736-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Information asymmetries and the agency relationship are two defining features of the healthcare system. These market failures are often used as a rationale for government intervention. Many countries have government financing and provision of healthcare in order to correct for this, while health technology agencies also exist to improve efficiency. However, informational asymmetries and the resulting principal-agent problem still persist, and one example is the lack of cost awareness amongst clinicians. This study explores the cost awareness of clinicians across different settings. METHODS We targeted four clinical cohorts: medical students, Senior House Officers/Interns, Mid-grade Senior Registrar/Residents, and Consultant/Attending Physicians, in six hospitals in the United Kingdom, the United States, Australia, New Zealand and Spain. The survey asked respondents to report the cost (as they recalled) of different types of scans, visits, medications and tests. Our analysis focused on the differential between the perceived/recalled cost and the actual cost. We explored variation across speciality, country and other potential confounders. Cost-awareness levels were estimated based on the cost estimates within 25% of the actual cost. RESULTS We received 705 complete responses from six sites across five countries. Our analysis found that respondents often overestimated the cost of common tests while underestimating high-cost tests. The mean cost-awareness levels varied between 4 and 23% for different items. Respondents acknowledged that they did not feel they had received adequate training in cost awareness. DISCUSSION The current financial climate means that cost awareness and the appropriate use of scarce healthcare resources is more paramount than perhaps ever before. Much of the focus of health economics research is on high-cost innovative technologies, yet there is considerable waste in the system with respect to overtreatment and overdiagnosis. Common reasons put forward for this include defensive medicine, poor education, clinical uncertainty and the institution of protocols. CONCLUSION Given the role of clinicians in the healthcare system, as agents both for patients and for providers, more needs to be done to remove informational asymmetries and improve clinician cost awareness.
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Affiliation(s)
- Jeremy Fabes
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, UK
| | - Jonathan Spiro
- Royal Perth Hospital, University of Western Australia, Perth, WA, Australia
| | - Thomas Fernandez
- Department of Anaesthesia, University of Auckland, Auckland, New Zealand
| | - Helge Eilers
- Dept of Anesthesia, University of California, San Francisco, CA, USA
| | - Steve Evans
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Amelia Hessheimer
- General & Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Paula Lorgelly
- Department of Applied Health Research, University College London, London, UK
- Department of Anaesthesia, University of Auckland, Auckland, New Zealand
| | - Michael Spiro
- Royal Free Perioperative Research Group, Royal Free Hospital NHS Foundation Trust, London, UK.
- Division of Surgery and Interventional Science, University College London, London, UK.
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Fadare JO, Enwere OO, Adeoti AO, Desalu OO, Godman B. Knowledge and Attitude of Physicians Towards the Cost of Commonly Prescribed Medicines: A Case Study in Three Nigerian Healthcare Facilities. Value Health Reg Issues 2020; 22:68-74. [PMID: 32798837 DOI: 10.1016/j.vhri.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE One of the core principles of rational prescribing is consideration of the cost of the medicines prescribed, especially in countries with high patient copayments and low incomes such as Nigeria. Little is known about Nigerian physicians' knowledge about the cost of commonly prescribed medicines. The principal objective of the study was to assess the knowledge of Nigerian physicians about the cost of commonly prescribed medicines. METHODS Descriptive cross-sectional survey conducted among physicians in 3 tertiary institutions in Nigeria. Apart from socio-demographic and other information, questions about the estimated costs of branded and generic versions of 11 commonly prescribed medications were included in the questionnaire. RESULTS One hundred and seventy-nine (179; 95.7%) respondents agreed that costs of medicines were important when writing prescriptions, although only 7 (3.7%) of them had any formal training in the economics of healthcare. The median percentages of respondents with accurate estimated costs for generic and originator brands were 6.2% and 12%, respectively. Respondents were more knowledgeable about the cost of medicines used for the treatment of infectious diseases (malaria, bacterial infections) than noncommunicable diseases (diabetes mellitus, hypertension, and dyslipidemia). CONCLUSIONS The knowledge of Nigerian physicians in the 3 participating hospitals about the costs of commonly prescribed medicines was poor. This is despite their awareness about the importance of costs of medicines when prescribing.
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Affiliation(s)
- Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria.
| | - Okezie O Enwere
- Department of Medicine, Imo State University, Orlu, Imo State, Nigeria
| | - Adekunle O Adeoti
- Department of Medicine, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | - Olufemi O Desalu
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
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Eriksen J, Ovesjö ML, Vallin M, Juhasz-Haverinen M, Andersén-Karlsson E, Ateva K, Gustafsson LL, Jirlow M, Bastholm-Rahmner P. Primary care physicians report high trust in and usefulness of the Stockholm drug and therapeutic committee's list of recommended essential medicines (the 'Wise List'). Eur J Clin Pharmacol 2017; 74:131-138. [PMID: 29063149 PMCID: PMC5748393 DOI: 10.1007/s00228-017-2354-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
Purpose Inappropriate use of medicines causes increased morbidity, mortality, adverse drug reactions, therapeutic failures and drug resistance as well as wastes valuable resources. Evidence-based cost-effective treatment recommendations of essential medicines are a way of avoiding these. We assessed primary care prescribers’ knowledge about and perceptions of an essential medicines formulary, as well as the reasons for adhering to the recommendations. Methods We conducted a web based questionnaire survey targeting all physicians working in the primary healthcare of the Stockholm healthcare region (2.3 million inhabitants), regarding the knowledge of, attitudes to and usefulness of the essential medicines formulary of the Stockholm Drug and Therapeutics Committee, the so-called Wise List. Results Of the 1862 physicians reached by our e-mail invitations, 526 (28%) participated in the survey. All but one respondent knew of the formulary, and 72% used it at least once a week when prescribing. The main reason for using the formulary was evidence-based prescribing; 97% trusted the guidelines, and almost all (98%) found the content easy to understand. At the same time, many prescribers thought that the annual changes of some recommendations were too frequent, and some felt that a national formulary would increase its trustworthiness. Conclusions We found that the essential medicines formulary was widely used and trusted by the prescribers. The high uptake of the treatment recommendations could be due to the Stockholm Drug and Therapeutics Committee’s transparent process for developing recommendations involving respected experts and clinicians using strict criteria for handling potential conflicts of interest, feedback to prescribers, continuous medical education and minor financial incentives. Electronic supplementary material The online version of this article (10.1007/s00228-017-2354-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Marie-Louise Ovesjö
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Quality and Development, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Martina Vallin
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | | | - Eva Andersén-Karlsson
- Department of Clinical Science and Education, Södersjukhuset, 118 83, Stockholm, Sweden.,Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Ateva
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Lars L Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, 141 86, Stockholm, Sweden
| | - Malena Jirlow
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Pia Bastholm-Rahmner
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
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Das M, Choudhury S, Maity S, Hazra A, Pradhan T, Pal A, Roy RK. Generic versus branded medicines: An observational study among patients with chronic diseases attending a public hospital outpatient department. J Nat Sci Biol Med 2017; 8:26-31. [PMID: 28250671 PMCID: PMC5320819 DOI: 10.4103/0976-9668.198351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The concept of generic prescription is widely accepted in various parts of the world. Nevertheless, it has failed to gain popularity in India due to factors such as nonavailability and distrust on the product quality. However, since 2012, the Government of West Bengal, India, has initiated exclusive generic drug outlets called “fair price medicine shop” (FPMS) inside the government hospital premises in a “public-private-partnership” model. This study was undertaken to evaluate the experience and attitude of patients who were consuming generic drugs purchased from these FPMS. Materials and Methods: It was a questionnaire-based cross-sectional study where we have interviewed 100 patients each consuming generic and branded drugs, respectively. The perceived effectiveness, reported safety, medication adherence, cost of therapy, and availability of drugs was compared between two mentioned groups. Medication adherence was estimated through Drug Attitude Inventory-10. Results: 93% of generic and 87% branded drug users believed that their drugs were effective (P = 0.238) in controlling their ailments. No significant difference (9% generic, 10% branded drug users, P = 1.000) was observed in reported adverse effects between generic and branded drug users. 82% and 77% of patients were adherent generic and branded drugs, respectively (P = 0.289). As expected, a significantly lower cost of generic drugs was observed compared to its branded counterpart. Conclusion: The policy of FPMS implemented by the Government of West Bengal, India appeared to be promising in terms of perceived effectiveness, safety, and adherence of generic drugs from FPMS compared to drugs purchased from open market retailers. Therefore, this study might act as an impetus for the policy-makers to initiate similar models across the country.
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Affiliation(s)
- Manisha Das
- Department of Pharmacology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Supriyo Choudhury
- Department of Pharmacology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Somnath Maity
- Department of Pharmacology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Tirthankar Pradhan
- Undergraduate Student, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Aishee Pal
- Undergraduate Student, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Ranendra Kumar Roy
- Department of Pharmacology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. Health-related quality of life measured using the EQ-5D-5L: South Australian population norms. Health Qual Life Outcomes 2016; 14:133. [PMID: 27644755 PMCID: PMC5028927 DOI: 10.1186/s12955-016-0537-0] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although a five level version of the widely-used EuroQol 5 dimensions (EQ-5D) instrument has been developed, population norms are not yet available for Australia to inform the future valuation of health in economic evaluations. The aim of this study was to estimate HrQOL normative values for the EQ-5D-5L preference-based measure in a large, randomly selected, community sample in South Australia. METHODS The EQ-5D-5L instrument was included in the 2013 South Australian Health Omnibus Survey, an interviewer-administered, face-to-face, cross-sectional survey. Respondents rated their level of impairment across dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and global health rating on a visual analogue scale (EQ-VAS). Utility scores were derived using the newly-developed UK general population-based algorithm and relationships between utility and EQ-VAS scores and socio-demographic factors were also explored using multivariate regression analyses. RESULTS Ultimately, 2,908 adults participated in the survey (63.4 % participation rate). The mean utility and EQ-VAS scores were 0.91 (95 CI 0.90, 0.91) and 78.55 (95 % CI 77.95, 79.15), respectively. Almost half of respondents reported no problems across all dimensions (42.8 %), whereas only 7.2 % rated their health >90 on the EQ-VAS (100 = the best health you can imagine). Younger age, male gender, longer duration of education, higher annual household income, employment and marriage/de facto relationships were all independent, statistically significant predictors of better health status (p < 0.01) measured with the EQ-VAS. Only age and employment status were associated with higher utility scores, indicating fundamental differences between these measures of health status. CONCLUSIONS This is the first Australian study to apply the EQ-5D-5L in a large, community sample. Overall, findings are consistent with EQ-5D-5L utility and VAS scores reported for other countries and indicate that the majority of South Australian adults report themselves in full health. When valuing health in Australian economic evaluations, the utility population norms can be used to estimate HrQOL. More generally, the EQ-VAS score may be a better measure of population health given the smaller ceiling effect and broader coverage of HrQOL dimensions. Further research is recommended to update EQ-5D-5L population norms using the Australian general population specific scoring algorithm once this becomes publically available.
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Affiliation(s)
- Nikki McCaffrey
- Flinders Health Economics Group, Flinders University, Repatriation General Hospital, Rm 55, Level 1, Block A, Repatriation General Hospital, Daws Road, Daw Park, SA, 5041, Australia. .,Palliative and Supportive Care, Bedford Park, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Billingsley Kaambwa
- Flinders Health Economics Group, Flinders University, Repatriation General Hospital, Rm 55, Level 1, Block A, Repatriation General Hospital, Daws Road, Daw Park, SA, 5041, Australia
| | - David C Currow
- Palliative and Supportive Care, Bedford Park, Flinders University, Bedford Park, SA, 5042, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, Flinders University, Repatriation General Hospital, Rm 55, Level 1, Block A, Repatriation General Hospital, Daws Road, Daw Park, SA, 5041, Australia
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