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

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.