Yelp for Prescribers: A Quasi-Experimental Study of Providing Antibiotic Cost Data and Prescription of High-Cost Antibiotics in an Academic and Tertiary Care Hospital

J Gen Intern Med. 2015 Aug;30(8):1140-6. doi: 10.1007/s11606-015-3253-2. Epub 2015 Mar 7.


Background: Physicians frequently prescribe antibiotics to inpatients without knowledge of medication cost. It is not well understood whether providing cost data would change prescribing behavior.

Objective: To evaluate the association between providing cost data alongside culture and antibiotic susceptibility results and prescribing of high-cost antibiotics.

Design: Quasi-experimental pre-post analysis.

Participants: Inpatients diagnosed with bacteremia or urinary tract infection in two tertiary care hospitals.

Intervention: Cost category data for each antibiotic ($, $$, $$$, or $$) were added to culture and susceptibility testing results available to physicians.

Main measures: Average cost category of antibiotics prescribed to patients after the receipt of susceptibility testing results.

Key results: There was a significant decrease in the average cost category of antibiotics per patient after the intervention (pre-intervention = 1.9 $ vs. post-intervention = 1.7 $, where 1.5 $ would mean that the average number of dollar signs for antibiotics prescribed was between $ and $$, p = 0.002). After adjusting for age, insurance type, and prior length of stay, the odds ratio (OR) of a patient's average antibiotic being higher cost vs. lower cost after the intervention compared to before the intervention was 0.74 [95% confidence interval (CI) 0.56, 0.98]. The intervention was associated with a 31.3% reduction in the average cost per unit of antibiotics prescribed (p < 0.001).

Conclusions: Providing physicians with cost feedback alongside susceptibility testing data was associated with a significant decrease in prescription of high-cost antibiotics. This intervention is intuitive, low cost, and may shift providers toward lower cost medications when equally acceptable options are available.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers / methods*
  • Adult
  • Aged
  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / drug therapy
  • Bacteremia / microbiology
  • Bacteria / drug effects
  • Bacteria / isolation & purification
  • Cost Savings
  • Drug Costs / statistics & numerical data*
  • Drug Prescriptions / economics*
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Humans
  • Logistic Models
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Non-Randomized Controlled Trials as Topic
  • Practice Patterns, Physicians'*
  • Retrospective Studies
  • Tertiary Care Centers*
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology


  • Anti-Bacterial Agents