Cost Effectiveness of Two Interventions for Reducing Outpatient Prescribing Costs

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Abstract
This prospective, randomized, controlled trial, based in a Veterans Administration Hospital general medicine clinic, compared the cost effectiveness of two behaviorally oriented interventions designed to reduce physicians' drug prescribing costs. Clinical pharmacists visited one group of 11 physicians during weekly clinic sessions to counterdetail the prescribing of certain targeted drugs. A second group of 10 physicians were given data each week comparing their individual prescribing costs to those of their colleagues (peer-comparison feedback). A control group of 10 physicians received neither intervention. Written patient-specific suggestions for cost-effective prescribing were employed in both intervention groups. Baseline prescribing costs were monitored through the hospital's computer during a three-month, preintervention period and a seven-month intervention period. The 2026 written suggestions made by the doctors of pharmacy resulted in 613 (30.3 percent) prescribing changes, including deletion, substitution, or change in dosage of targeted drugs. There were no intergroup differences in the response to written suggestions. However, the group receiving face-to-face visits from the clinical pharmacists achieved lower average prescription costs than the control group during seven of eight months. Intergroup differences were statistically significant (p < 0.05) during three of the last five months of the study. The face-to-face meeting intervention was cost-effective, saving $478 per physician over seven months after accounting for Pharm.D. salary costs. There was no significant decrease in the number of prescriptions written by the face-to-face group compared with the control group, suggesting that drug substitution rather than deletion was the method used by physicians to lower drug costs. No savings resulted from the use of peer-comparison feedback. We conclude that personal visits by a Pharm.D. are a cost-effective technique for reducing physicians' prescribing costs, and are superior to peer-comparison feedback.