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Charge Awareness Affects Treatment Choice: Prospective Randomized Trial in Pediatric Appendectomy

Russell, Katie W. MD*; Rollins, Michael D. MD*; Barnhart, Douglas C. MD, MSPH*; Mone, Mary C. RN, BSE*; Meyers, Rebecka L. MD*; Skarda, David E. MD*; Soukup, Elizabeth S. MD*; Black, Richard E. MD*; Molitor, Mark S. MD*; Stoddard, Gregory J. MS; Scaife, Eric R. MD*

doi: 10.1097/SLA.0000000000000885
Original Articles

Objective: To determine whether charge awareness affects patient decisions.

Background: Pediatric uncomplicated appendicitis can be treated with open or laparoscopic techniques. These 2 operations are considered to have clinical equipoise.

Methods: In a prospective, randomized clinical trial, nonobese children admitted to a children's hospital with uncomplicated appendicitis were randomized to view 1 of 2 videos discussing open and laparoscopic appendectomy. Videos were identical except that only one presented the difference in surgical materials charges. Patients and parents then choose which operation they desired. Videos were available in English and Spanish. A postoperative survey was conducted to examine factors that influenced choice. The trial was registered at (NCT 01738750).

Results: Of 275 consecutive cases, 100 met enrollment criteria. In the group exposed to charge data (n = 49), 63% chose open technique versus 35% not presented charge data (P = 0.005). Patients were 1.8 times more likely to choose the less expensive option when charge estimate was given (95% confidence interval, 1.17–2.75). The median total hospital charges were $1554 less for those who had open technique (P < 0.001) and $528 less for the group exposed to charge information (P = 0.033). Survey found that 90% of families valued having input in this decision and 31% of patients exposed to charge listed it as their primary reason for their choice in technique.

Conclusions: Patients and parents tended to choose the less expensive but equally effective technique when given the opportunity. A discussion of treatment options, which includes charge information, may represent an unrealized opportunity to affect change in health care spending.

Supplemental Digital Content is Available in the Text.In a clinical trial of 2 equivalent operations, randomized to exposure or nonexposure of information relevant to surgical cost of care, those exposed to cost information were more likely to choose the less costly procedure. Prior provision of pertinent charge information may be a potential opportunity for reducing health care costs.

Departments of *Surgery and

Internal Medicine, University of Utah, Salt Lake City, UT.

Reprints: Katie W. Russell, MD, Department of Surgery, School of Medicine, University of Utah, 30 N 1900 E, 3B 110, Salt Lake City, UT 84132. E-mail:

Disclosure: Supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant 8UL1TR000105 (formerly UL1RR025764) (to G.J.S). The authors declare no conflicts of interest.

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