Understanding the cost of dermatologic care: A survey study of dermatology providers, residents, and patients

No longer a blank cheque: a narrative scoping review of physician awareness of cost

OBJECTIVES

Healthcare costs have been steadily rising, and attention to cost containment in healthcare systems is increasingly important. It has been previously established that physicians lack adequate awareness of cost in health care and that by increasing awareness, costs can be reduced. This scoping review examines cost awareness of medications, investigations and procedures and identifies potential interventions that may serve to improve physician awareness.

STUDY DESIGN

A scoping review was performed to evaluate the literature based on established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

A review of electronic databases was performed for studies regarding physician awareness of cost, including PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar.

RESULTS

An initial 4350 citations were identified, and 76 articles were included for full text analysis. Combined, these studies assessed 18,901 physicians. The overwhelming majority (91%) found cost awareness in physicians was low and demonstrated significant room for cost reduction. Eighteen of the 76 studies assessed an intervention to improve physician awareness of cost and used either a price list (89%) or a teaching session (11%) as the primary intervention.

CONCLUSIONS

Research demonstrates that there is still a lack of awareness among physicians of the costs of medications, investigations and procedures/consumables. Initial approaches using price display and teaching sessions have shown promise. Further research into best practices for education around cost, beginning in medical school and continuing into established medical and surgical practices, may lead to increased cost savings in health care.

Demand for and Occurrence of Medication Cost Conversations: A Narrative Review

High medication prices can create a financial burden for patients and reduce medication initiation. To improve decision making, public policy is supporting development of tools to provide real-time prescription drug prices. We reviewed the literature on medication cost conversations to characterize the context in which these tools may be used. Our review included 42 articles: a median of 84% of patients across four clinical specialties reported a desire for cost conversations (n = 7 articles) but only 23% reported having held a cost conversation across six specialties (n = 16 articles). Non-White and older patients were less likely to report having held a cost conversation than White and younger patients in 9 of 13 and 5 of 9 articles, respectively, examining these associations. Our review indicates that tools providing price information may not result in improved decision making without complementary interventions that increase the frequency of cost conversations with a focus on protected groups.

Physician Perspectives on the Effect of Topical Steroid Costs on Patients and Proposed Solutions

Importance

Rising costs of topical steroids have increased overall health care and patient out-of-pocket costs while increasing administrative burden on dermatologists and office staff.

Objective

To explore factors affecting the decision-making process for dermatologists around topical steroid prescriptions, determine the association of insurance coverage and cost, and assess willingness to implement solutions to decrease out-of-pocket topical steroid costs for patients.

Design, Setting, and Participants

This qualitative study was conducted from June to November 2020 and used semistructured interviews of 16 dermatologists who reflected a mix of physicians in academic, nonacademic, and private practice until thematic saturation was reached. Each interview was independently coded by 2 researchers. Code frequency and interrater reliability were determined using NVIVO software. Data analysis was conducted from November 2020 to March 2021.

Main Outcomes and Measures

Factors influencing dermatologist decision-making around topical steroid selection, outcomes of unaffordable medications on patients, solution recommendations, and perspectives on a system to automatically substitute topical steroid for cheaper alternatives of the same class and vehicle.

Results

Of the 16 dermatologists, 8 (50.0%) were women, 8 (50.0%) were men, 1 (6.3%) was Asian, 2 (12.5%) were Latinx, and 12 (75.0%) were White. The interrater reliability ranged from κ = 0.86 to κ = 0.98, indicating excellent agreement. Most physicians (13 [81%]) thought about costs regularly when making choices about topical steroids. All physicians identified a scenario in which patients could not obtain medication based on cost. In these cases, 15 (94%) reported that they try to find an alternative medication by calling the pharmacist or insurance company. Despite a desire to consider cost at the time of prescribing, physicians reported not knowing medication costs before prescribing because of the variability of insurance coverage (15 [94%]), lack of transparency (12 [75%]), and fluctuating drug prices (12 [75%]). In addition to affecting patients, 14 physicians (88%) reported that a patient's inability to afford medications increases administrative burden. Physicians suggested that they were open to solutions that focused on increased cost transparency (10 [63%]) and improved electronic health record technologies. Furthermore, 14 (88%) were willing to use a system to allow the substitution of one topical steroid for another of the same class and vehicle.

Conclusions and Relevance

The results of this qualitative study suggest that opacity around drug costs reduces access for patients and is followed by administrative stress for physicians and staff. Dermatologists are receptive to systems that provide greater transparency for drug costs or automate substitution of equivalent cheaper drugs for patients.

Cost considerations of dermatological care in Jordan: a cross-sectional study

Background: Physicians play a key role in improving patient adherence, specifically in dermatological care. Expensive medications are associated with poor patient adherence and worsening clinical outcomes. This study aims to explore the cost estimation interest of patients with dermatological conditions, the influence of the cost on their drug use behavior, and cost communication practices by dermatologists.Method: A cross-sectional study was conducted between October 2019 and January 2020 in Jordan. Logistic regression was conducted to explore the predictors of patient behavior.Results:A total of 1,022 patients participated in the study. Around 27.7% of them reported that their dermatologist does not discuss the cost of medications with them. About 71.4% reported that it is important for them to receive cost estimates for out of pocket medication costs. Patients with an income of 300 JD to 700 JD were more likely to be interested in cost estimations. Employed patients and males were less likely to be interested in cost estimations (p < 0.05).Conclusion: There is a considerable proportion of dermatologists who do not adhere to communicate about cost with their patients. Such communication should be considered necessary with all patients to enhance adherence to their prescribed therapy.

Cost awareness in urology: A nationwide survey

Introduction:

In the current economic climate with continuous expenditure reviews and financial constraints, clinicians should remain conscious of making cost-effective choices on consumables and medications. In this survey, we evaluated the cost awareness amongst UK urologists. This is an observational study in which urology clinicians were asked to estimate the cost of 10 commonly used medications and consumables in urology by completing a questionnaire.

Methodology:

The survey was primarily conducted at the BAUS Annual Meeting 2017 with subsequent responders at local hospitals and urological courses. The costs of consumables and medications were verified with the relevant companies and the 73rd edition of the British National Formulary.

Result:

There were 139 responders from across the UK (46 consultants, 64 training registrars, 13 trust grades doctors and 16 senior house officers (SHOs)). In total, 16 and 60% of all estimates were within ± 25% and ± 100% of the true cost of the items respectively. Approximately 97.1, 95.7 and 97.1% overestimated the cost of a 14Ch urethral catheter, Ciprofloxacin and Sildenafil, respectively; while 78.4 and 84.9% of responders underestimated the cost of a JJ ureteric stent and Solifenacin, respectively. On multivariate analysis, SHOs significantly overestimated the cost of urethral catheters, suprapubic catheterization kits and JJ ureteric stents compared to other clinician grades.

Conclusion:

Cost awareness among UK urologists is poor. Expensive items (e.g. JJ ureteric stent, Solifenacin) tend to be underestimated while inexpensive items (e.g. catheter, Ciprofloxacin, Sildenafil) tend to be overestimated. This lack of appreciation of value may have an impact on drug and consumable expenditure.

Level of Evidence:

Level 3