Physician awareness of drug cost: a systematic review.
Physician awareness of drug cost: a systematic review.
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DOI：
10.1371/journal.pmed.0040283
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发表时间：
2007-09
期刊：
影响因子：
15.8
通讯作者：
Wiebe N
中科院分区：
文献类型：
--
作者：
Allan GM;Lexchin J;Wiebe N
在大多数发达国家，药品费用是增长最快的医疗保健费用。较高的药品成本已被证明会对患者的治疗结果产生负面影响。研究表明，医生对药品成本了解甚少，但数据各不相同，而且认识也没有一致的模式。我们设计这项系统评价的目的是调查医生对药物相对和绝对成本的了解，并确定影响意识的因素。我们的检索策略包括 Cochrane 图书馆、EconoLit、EMBASE 和 MEDLINE 以及参考文献列表，以及与发表过两篇或更多关于该主题的文章或在我们的综述开始后 10 年内发表过文章的作者的联系。如果满足以下条件，则纳入研究： 医生、实习生（实习生或住院医师）或医学生接受了调查；调查受访者超过十人；估计药品成本；结果以定量方式表达；明确描述了作者如何定义“准确估计”；并且描述了如何确定真实成本。两位作者审查了每篇文章的资格并独立提取数据。总结了成本准确性结果，但由于广泛的异质性，数据未合并在荟萃分析中。还提取了与医生和药品成本相关的定性数据。最终分析包括24篇文章。成本准确度低； 31% 的估算与真实成本的误差在 20% 或 25% 以内，并且无论从成本准确性的任何定义来看，准确的估算都低于 50%。方法学上的弱点很常见，方法学质量低的研究显示出更好的成本意识。影响估计模式和准确性的最重要因素是真实的治疗费用。高成本药物的估计比廉价药物更准确（74% 比 31%，卡方 p < 0.001）。医生始终高估廉价产品的成本，低估昂贵产品的成本（二项式检验，89/101，p < 0.001）。当被问及时，医生表示他们想要成本信息，并认为这会改善他们的处方，但无法获得。医生对成本的无知，加上他们倾向于低估昂贵药物的价格和高估廉价药物的价格，表明他们缺乏对廉价药物和昂贵药物之间巨大成本差异的认识。这种差异反过来可能会对总体药物支出产生深远的影响。需要更多地关注对医生进行有关费用和获取费用信息的教育。未来的研究应重点关注医疗费用信息的可访问性和可靠性，以及这些信息的提供是否被医生使用以及对医生的处方是否产生影响。此外，未来的工作应争取更高的方法学标准，以避免我们在当前文献中发现的偏差，包括关注评估准确性的方法，以允许昂贵药物的绝对估计范围更大。 Michael Allan 及其同事通过对 24 项研究数据的回顾得出结论，医生经常低估昂贵药物的价格，而高估廉价药物的价格。许多药物非常昂贵，购买它们的成本占医疗保健总成本的主要（并且不断增加）比例。各国政府和医疗保健组织试图找到降低成本而又不降低其提供的医疗保健有效性的方法，但他们控制药品支出的努力并不十分成功。通常有两种或多种同等有效的药物可用于治疗相同的病症，如果医生在开药时选择最便宜的有效药物，显然将有助于降低成本。这种选择可以为支付药物费用的任何人带来节省，无论是政府、患者还是医疗保险组织。开药的医生不能知道市场上每种药物的确切成本，但如果他们对治疗成本以及各种替代方案的价格比较有一些了解，将会很有帮助。然而，决定药品定价方式的系统通常非常复杂。 （在美国尤其如此。）研究人员想了解医生对药物成本以及替代方案之间的差异的了解程度。他们还想知道哪些因素影响了他们的意识。他们决定对已经进行的所有解决该问题的研究进行系统审查，以便可以综合考虑所有研究的证据。为了进行这样的审查，他们必须对要纳入的研究类型明确具体要求，然后全面搜索此类研究的医学文献。他们找到了 24 项符合他们要求的研究。从这些研究中，他们得出的结论是，当医生被要求估计药物成本时，他们通常不准确；在不到三分之一的情况下，医生得出的估算值与真实成本的误差在 25% 以内。特别是，医生往往会低估昂贵药物的成本，并高估较便宜替代品的成本。对这些研究的进一步分析表明，许多医生表示，他们希望获得更准确的费用信息，以帮助他们选择开哪种药物，但这些信息并不容易获得。研究人员得出的结论是，他们的系统审查表明，开处方的医生缺乏对廉价药物和昂贵药物之间巨大成本差异的认识，这一发现对药物总体支出具有严重影响。他们呼吁向医生提供更多有关药品成本的教育和信息，并提供更好的流程来帮助医生做出此类决定。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0040283。 BMJ（英国医学杂志）出版了系统评价的简要指南。Cochrane 协作组织的网站是有关系统评价的更详细的信息来源；特别是为医疗保健消费者提供新移民指南和信息凯撒家庭基金会是一个非营利性私人运营基金会，专注于美国的主要医疗保健问题，其中有一个关于处方药及其费用的部分
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. 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. 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. From a review of data from 24 studies, Michael Allan and colleagues conclude that doctors often underestimate the price of expensive drugs and overestimate the price of those that are inexpensive. Many medicines are extremely expensive, and the cost of buying them is a major (and increasing) proportion of the total cost of health care. Governments and health-care organizations try to find ways of keeping down costs without reducing the effectiveness of the health care they provide, but their efforts to control what is spent on medicines have not been very successful. There are often two or more equally effective drugs available for treating the same condition, and it would obviously help keep costs down if, when a doctor prescribes a medicine, he or she chose the cheapest of the effective drugs available. This choice could result in savings for whoever is paying for the drugs, be it the government, the patient, or a medical insurance organization. Doctors who prescribe drugs cannot be expected to know the exact cost of each drug on the market, but it would he helpful if they had some impression of the cost of a treatment and how the various alternatives compare in price. However, systems deciding how drugs are priced are often very complex. (This is particularly the case in the US.) The researchers wanted to find out how aware doctors are regarding drug costs and the difference between the alternatives. They also wanted to know what factors affected their awareness. They decided to do a systematic review of all the research already conducted that addressed this issue so that the evidence from all of them could be considered together. In order to do such a review they had to specify precise requirements for the type of study that they would include and then comprehensively search the medical literature for such studies. They found 24 studies that met their requirements. From these studies, they concluded that doctors were usually not accurate when asked to estimate the cost of drugs; doctors came up with estimates that were within 25% of the true cost less than one-third of the time. In particular doctors tended to underestimate the cost of expensive drugs and overestimate the cost of the cheaper alternatives. A further analysis of the studies showed that many doctors said they would appreciate more accurate information on costs to help them choose which drugs to prescribe but that such information was not readily available. The researchers concluded that their systematic review demonstrates a lack of appreciation by prescribing doctors of the large difference in cost between inexpensive and expensive drugs, and that this finding has serious implications for overall spending on drugs. They call for more education and information to be provided to doctors on the cost of medicines together with better processes to help doctors in making such decisions. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040283. A brief guide to systematic reviews has been published by the BMJ (British Medical Journal) The Web site of the Cochrane Collaboration is a more detailed source of information on systematic reviews; in particular there is a newcomers' guide and information for health-care consumers The Kaiser Family Foundation, a nonprofit, private operating foundation focusing on the major health care issues in the US, has a section on prescription drugs and their costs
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影响因子：
2.2
作者：
Barclay, S;Todd, C;Wyatt, P
通讯作者：
Wyatt, P
影响因子：
4.4
作者：
Bowling, A
通讯作者：
Bowling, A
影响因子：
4.4
作者：
Bernstein, SL;Whitaker, D;Brennan, JA
通讯作者：
Brennan, JA
影响因子：
38.9
作者：
Conti, G;Dell'Utri, D;Gasparetto, A
通讯作者：
Gasparetto, A
DOI：
10.1097/00005373-199512000-00004
发表时间：
1995-12-01
影响因子：
--
作者：
Blackstone, ME;Miller, RS;Stein, MA
通讯作者：
Stein, MA