Effects of price information on test ordering in an intensive care unit

Abstract.

Objective: To determine if daily information on the price of common laboratory tests and chest X-ray could significantly influence test ordering by physicians and decrease the costs. Design: A prospective observational and sequential study. Setting: A 21-bed surgical intensive care unit of a university hospital. Patients: All patients admitted during a 4-month period. Interventions: A 2-month period served as control (period I). During a consecutive 2-month period (period II) physicians were informed about the costs of seven common diagnostic tests (plasma and urinary electrolytes, arterial blood gases, blood count, coagulation test, liver function test and chest X-ray). The number of tests ordered and costs during the two periods were compared. Measurements and results: A total of 287 patients were included (128 in period I and 159 in period II). Information about age, gender, Severe Acute Physiologic Score II, McCabe score, intensive care unit length of stay and mortality were collected and were not statistically different between the two study periods. Except for liver function tests, all the tests evaluated were less frequently prescribed when physicians were aware of the charges, irrespective of whether the tests were routine or requested during an emergency. Nevertheless, a significant reduction was obtained only for arterial blood gases and urinary electrolytes. Overall analysis of the expenditures (in Euros) showed a significant 22% decrease in period II (341±500 versus 266±372 Euros, p<0.05). Conclusion: Providing price information to physicians was associated with a significant reduction for arterial blood gases and urinary electrolytes tests ordered and was significantly cost-saving.