Cost awareness of physicians in intensive care units: a multicentric national study

• DOI: 10.1007/s00134-015-3859-1
• Publication Date: 2015-05-21T10:21:19Z
• Authors: Romain Hernu; Martin Cour; Sylvie de la Salle; Dominique Robert; Laurent Argaud
• Keywords: Adult; Male; Health Knowledge, Attitudes, Practice; Health Care Costs/*statistics & numerical data; [SDV]Life Sciences [q-bio]; 03 medical and health sciences; 0302 clinical medicine; Physicians; Surveys and Questionnaires; Humans; Hospital Costs; 360; Practice; Health Knowledge; Health Care Costs; Quality Improvement; Prescriptions/*economics; 3. Good health; [SDV] Life Sciences [q-bio]; Intensive Care Units; Prescriptions; Attitudes; Hospital Costs/*statistics & numerical data; Female; France; Intensive Care Units/*economics

Physicians play an important role in strategies to control health care spending. Being aware of the cost of prescriptions is surely the first step to incorporating cost-consciousness into medical practice. The aim of this study was to evaluate current intensivists' knowledge of the costs of common prescriptions and to identify factors influencing the accuracy of cost estimations.Junior and senior physicians in 99 French intensive care units were asked, by questionnaire, to estimate the true hospital costs of 46 selected prescriptions commonly used in critical care practice.With an 83% response rate, 1092 questionnaires were examined, completed by 575 (53%) and 517 (47%) junior and senior intensivists, respectively. Only 315 (29%) of the overall estimates were within 50% of the true cost. Response errors included a 14,756 ± 301 € underestimation, i.e., -58 ± 1% of the total sum (25,595 €). High-cost drugs (>1000 €) were significantly (p < 0.001) the most underestimated prescriptions (-67 ± 1%). Junior grade physicians underestimated more costs than senior physicians (p < 0.001). Using multivariate analysis, junior physicians [odds ratio (OR), 2.1; 95% confidence interval (95% CI), 1.43-3.08; p = 0.0002] and female gender (OR, 1.4; 95% CI, 1.04-1.89; p = 0.02) were both independently associated with incorrect cost estimations.ICU physicians have a poor awareness of prescriptions costs, especially with regards to high-cost drugs. Considerable emphasis and effort are still required to integrate the cost-containment problem into the daily prescriptions in ICUs.