Yelp for Prescribers: A Quasi-Experimental Study of Providing Antibiotic Cost Data and Prescription of High-Cost Antibiotics in an Academic and Tertiary Care Hospital.
BACKGROUND
Physicians frequently prescribe antibiotics to inpatients without knowledge of medication cost. It is not well understood whether providing cost data would change prescribing behavior.


OBJECTIVE
To evaluate the association between providing cost data alongside culture and antibiotic susceptibility results and prescribing of high-cost antibiotics.


METHODS
Quasi-experimental pre-post analysis.


METHODS
Inpatients diagnosed with bacteremia or urinary tract infection in two tertiary care hospitals.


METHODS
Cost category data for each antibiotic ($, $$, $$$, or $$) were added to culture and susceptibility testing results available to physicians.


METHODS
Average cost category of antibiotics prescribed to patients after the receipt of susceptibility testing results.


RESULTS
There was a significant decrease in the average cost category of antibiotics per patient after the intervention (pre-intervention = 1.9 $ vs. post-intervention = 1.7 $, where 1.5 $ would mean that the average number of dollar signs for antibiotics prescribed was between $ and $$, p = 0.002). After adjusting for age, insurance type, and prior length of stay, the odds ratio (OR) of a patient's average antibiotic being higher cost vs. lower cost after the intervention compared to before the intervention was 0.74 [95% confidence interval (CI) 0.56, 0.98]. The intervention was associated with a 31.3% reduction in the average cost per unit of antibiotics prescribed (p < 0.001).


CONCLUSIONS
Providing physicians with cost feedback alongside susceptibility testing data was associated with a significant decrease in prescription of high-cost antibiotics. This intervention is intuitive, low cost, and may shift providers toward lower cost medications when equally acceptable options are available.
Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA, kira.newman@emory.edu.
Kira L
KL
Newman
Jay
J
Varkey
Justin
J
Rykowski
Arun V
AV
Mohan
D000046:Academic Medical Centers / Q000379:methods*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D017046:Cost Savings; D016527:Drug Costs / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents