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Comment & Response
December 2016

Costs of Inpatient Medications: Do Dispensing and Nursing Fees Lead to Overestimates?—Reply

Author Affiliations
  • 1Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
JAMA Intern Med. 2016;176(12):1882-1883. doi:10.1001/jamainternmed.2016.7258

In Reply We thank Drs MacMillan and Cavalcanti for their interest in our Research Letter,1 wherein we discuss the potential financial and labor wastes associated with docusate. MacMillan and Cavalcanti express concern that removing a single useless medication from the formulary is unlikely to lead to substantial cost savings and, further, that our projections are somewhat sensationalist. We concede that we did not perform a formal pharmacoeconomic analysis. Rather, we used rough estimates to put the very frequent use of an inexpensive but ineffective medication into a larger context of low-value health care. It is hard to call attention to a medication that costs pennies per dose, even though it may be nearly useless, until one realizes that hundreds of millions of doses are used. Docusate is but 1 example of the death of a thousand cuts that threaten the sustainability of health care.

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