Choosing Wisely: Next Steps

Impact of price display on provider ordering: A systematic review

Abstract

BACKGROUND

Displaying order prices to physicians is 1 potential strategy to reduce unnecessary health expenditures, but its impact on patterns of care is unclear.

OBJECTIVE

To review characteristics of previous price display interventions, impact on order costs and volume, effects on patient safety, acceptability to physicians, and the quality of this evidence.

DESIGN

Systematic review of studies that showed numeric prices of laboratory tests, imaging studies, or medications to providers in real time during the ordering process and evaluated the impact on provider ordering. Two investigators independently extracted data for each study and evaluated study quality using a modified Downs and Black checklist.

RESULTS

Of 1494 studies reviewed, 19 met inclusion criteria, including 5 randomized trials, 13 pre‐post intervention studies, and 1 time series analysis. Studies were published between 1983 and 2014. Of 15 studies reporting the quantitative impact of price display on aggregate order costs or volume, 10 demonstrated a statistically significant decrease in the intervention group. Price display was found to decrease aggregate order costs (9 of 13 studies) more frequently than order volume (3 of 8 studies). Patient safety was evaluated in 5 studies and was unaffected by price display. Provider acceptability tended to be positive, although evidence was limited. Study quality was mixed, with checklist scores ranging from 5/21 to 20/21.

CONCLUSIONS

Provider price display likely reduces order costs to a modest degree. Patient safety appeared unchanged, though evidence was limited. More high‐quality evidence is needed to confirm these findings within a modern context. Journal of Hospital Medicine 2016;11:65–76. © 2015 Society of Hospital Medicine

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