THE PRESENTATION OF COST-RELATED INFORMATION IN PATIENT DECISION AIDS

Purpose: To determine the frequency of cost-related information included in patient decision aids (PtDAs) and identify the common modes of presenting cost-related information. 

Method: We analyzed published PtDAs found in the Decision Aid Library Inventory (DALI) system, maintained by the Ottawa Hospital Research Institute (N=290). We recorded whether cost was mentioned, how many times, and how it was mentioned and performed descriptive statistical analysis on these data. 

Result: A total of 290 PtDAs were anlayzed. A majority of them (n = 161, 55%) mentioned cost in some way, but only 37 (13%) mentioned cost directly by giving a specific price or range of prices.

In addition to the provision of a specific price, cost was mentioned in 8 additional ways: as a benefit (e.g., “[the treatment] is low in cost”), a risk (e.g., “medicines cost a lot”), a “depends on insurance” clause, a statement of predication about insurance (e.g. “insurance usually covers this”), a comparison of costs (e.g., one option is cheaper than another), value and importance of cost (e.g., scale of worry or importance of cost), a suggestion to discuss costs with someone (e.g., physician, social worker, insurance provider), and a suggestion to [vaguely] "consider" cost. 

The most common way to mention cost was as a benefit (n = 73, 45%), followed by a risk (n = 54, 34%), depends on insurance (n = 54, 34%), and value and importance to you (n = 48, 30%). 23 of the decision aids that mentioned cost (14%) suggested talking to someone about the costs; of those, 14 suggested a doctor, 3 an insurance provider, and 9 either multiple sources or other. 

Decisions about medication option(s) were the type of decision where cost was most likely to be mentioned, with 73% of the decision aids about medication (n = 49) discussing cost in some way.

Conclusion: Whether costs are dicussed in PtDAs is highly variable, as is how they are discussed when they are. Best pracitces are needed for the presentation of cost information. The International Pateint Decision Aid Standards (IPDAS) Collaboration may consider taking on this issue.