Evidence map›Paper›PMID 28765138›Full record

ArticleBMJ open2017

Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals.

David G Li, Gordon X Wong, David T Martin, David J Tybor, Jennifer Kim, Jeffrey Lasker, Roger Mitty, Deeb Salem

Abstract read
In one paragraph

Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Navigating Ethical Practices in the Era of High Cost Hematology.Current hematologic malignancy reports · 2020
    Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

David G LiTufts University School of Medicine, Boston, Massachusetts, USA.
Gordon X WongTufts University School of Medicine, Boston, Massachusetts, USA.
David T MartinLahey Hospital and Medical Center, Burlington, Massachusetts, USA.
David J TyborTufts University School of Medicine, Boston, Massachusetts, USA.
Jennifer KimStanford Medical Center, Palo Alto, California, USA.
Jeffrey LaskerNew England Quality Care Alliance, Boston, Massachusetts, USA.
Roger MittySt. Elizabeth's Medical Center, Brighton, Massachusetts, USA.
Deeb SalemTufts Medical Center, Boston, Massachusetts, USA.

Funding

Tufts Clinical and Translational Research InstituteTL1TR001062 · NCATS · TUFTS UNIVERSITY BOSTON · PI SELKER, HARRY P. · 2013 to 2017
$2.1M
NCATS NIH HHS TL1 TR001062
6 · The paper itself

Abstract

objectiveTo determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making.

designIn this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population.

settingThree Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre.

participants819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories. MAIN OUTCOMES AND MEASURES: Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity.

resultsA total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001).

conclusionsCost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

Indexed as

Attitude of Health PersonnelClinical Decision-MakingCost-Benefit AnalysisHealth EquityInternship and ResidencyPhysiciansStudents, MedicalAdultBostonCross-Sectional StudiesDecision MakingFemaleHospitals, TeachingHumansMaleMiddle Agedcost-effectivenessdecision analysishealth policymedical equitymedical ethics

Identifiers

PMID28765138
PMCPMC5642791

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.