In late January 2022, JAMA Network Open published an original investigation, “Cost-effectiveness and Economic Benefit of Continuous Professional Development for Drug Prescribing.” The investigation reviewed the comparative costs and benefits of physician continuous professional development (CPD) for drug prescribing.
In conducting the research, the authors reviewed several databases (MEDLINE, Embase, PsycInfo, and the Cochrane Database) from their creation through April 23, 2020, for comparative studies that evaluated the cost of CPD for drug prescribing. Two reviewers independently screened all articles and reviewed all included articles to extract data on participants, educational interventions, study designs, and cost and effectiveness outcomes. Those results were then synthesized for educational costs, health care costs, and cost-effectiveness.
The study authors defined CPD as “activities intended to promote or measure the clinical knowledge/skills of physicians in independent medical practice through courses or assessments delivered in any modality or venue, whether or not continuing medical education (CME) credit is awarded; or self-directed learning or self-assessment activities for which CME credit is awarded.”
Out of all articles screened from the databased (3,338), 38 were included in the analysis. Of those studies, at least 15,659 health care professionals and 1,963,197 patients were included.
Educational Costs
After review, twelve studies reported on educational costs, with a range of $281 to $183,554 (median $15,664). Economic outcomes were evaluated in 33 studies, 31 of which found that, when compared with no intervention, CPD was associated with reduced drug costs of between $4,731 to $6,912,000 (median reduction of $79,373). Additionally, four studies found reduced drug costs for 1-on-1 outreach compared with other CPD approaches. The most commonly reported cost component was the cost of course faculty (7 studies), whereas 6 studies counted postage and 5 studies included the cost of educational materials. None of the studies itemized costs for equipment.
The average ingredient cost per intervention varied widely, from $58,897 for learner attendance to $1,022 for catering. The total reported educational cost also varied widely, ranging from just $281 to $183,554, with an average of $32,676 (SD $51,215).
Cost-Effectiveness
Nine studies reported costs and clinical outcomes for CPD when compared to no education. Eight studies reported an effectiveness outcome, all of which found improved prescribing outcomes (and increased cost) with CPD.
There were five studies that compared CPD and no intervention. Those studies found that the incremental cost-effectiveness ratio for a 10% improvement in prescribing ranged from $15,390 to $437,027 to train all program participants. Four comparisons of alternative CPD approaches found that 1-on-1 educational outreach was more effective (but more expensive) than group education or mailed materials.
Conclusion
While more intensive CPD was associated with an even greater effectiveness, greater education costs were also incurred. The authors therefore concluded that physician CPD for drug prescribing is associated with reduced healthcare costs and that effectiveness outcomes and costs should be considered when making education decisions. However, as part of that analysis, some ingredients are more contribute more to the total cost than others: time for learners, teachers, and administrators should be measured and reported accurately and consistently to better understand economic studies of education.