title: Charge Awareness Affects Treatment Choice: Prospective Randomized Trial in Pediatric Appendectomy.
abstract: OBJECTIVE
  To determine whether charge awareness affects patient decisions.
  
  
  BACKGROUND
  Pediatric uncomplicated appendicitis can be treated with open or laparoscopic techniques. These 2 operations are considered to have clinical equipoise.
  
  
  METHODS
  In a prospective, randomized clinical trial, nonobese children admitted to a children's hospital with uncomplicated appendicitis were randomized to view 1 of 2 videos discussing open and laparoscopic appendectomy. Videos were identical except that only one presented the difference in surgical materials charges. Patients and parents then choose which operation they desired. Videos were available in English and Spanish. A postoperative survey was conducted to examine factors that influenced choice. The trial was registered at ClinicalTrials.gov (NCT 01738750).
  
  
  RESULTS
  Of 275 consecutive cases, 100 met enrollment criteria. In the group exposed to charge data (n = 49), 63% chose open technique versus 35% not presented charge data (P = 0.005). Patients were 1.8 times more likely to choose the less expensive option when charge estimate was given (95% confidence interval, 1.17-2.75). The median total hospital charges were $1554 less for those who had open technique (P < 0.001) and $528 less for the group exposed to charge information (P = 0.033). Survey found that 90% of families valued having input in this decision and 31% of patients exposed to charge listed it as their primary reason for their choice in technique.
  
  
  CONCLUSIONS
  Patients and parents tended to choose the less expensive but equally effective technique when given the opportunity. A discussion of treatment options, which includes charge information, may represent an unrealized opportunity to affect change in health care spending.
authors.affiliation: Departments of *Surgery and †Internal Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Katie W
authors.initials: KW
authors.lastname: Russell
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rollins
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mone
authors.forename: Rebecka L
authors.initials: RL
authors.lastname: Meyers
authors.forename: David E
authors.initials: DE
authors.lastname: Skarda
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Soukup
authors.forename: Richard E
authors.initials: RE
authors.lastname: Black
authors.forename: Mark S
authors.initials: MS
authors.lastname: Molitor
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: Eric R
authors.initials: ER
authors.lastname: Scaife
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics / Q000379:methods* / Q000523:psychology; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D005260:Female; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000523:psychology; D008297:Male; D010290:Parents / Q000523:psychology; D011446:Prospective Studies