Assessing the effectiveness and cost-effectiveness of audit and feedback on physician’s prescribing indicators: study protocol of a randomized controlled trial with economic evaluation

A four-arm randomized trial with economic evaluation will be conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm will be compared. Physicians working in outpatient practices are randomly allocated to one of the four arms using stratified randomized sampling. The interventions are developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing will be assessed in regression analyses. Cost data will be assessed from a health care provider’s perspective and incremental cost-effectiveness ratios will be calculated.This study will determine the effectiveness and cost-effectiveness of three interventions and allow us to determine the most effective interventions in improving prescribing pattern. If the interventions are cost-effective, they will likely be applied nationwide.Iranian Registry of Clinical Trials Registration Number: IRCT201106086740N1Pharmaceutical Sciences Research Center of TUMS Ethics Committee Registration Number: 90-02-27-07Over the past decades, new generations of antibiotics, analgesics, corticosteroids and other medicines have been introduced to the pharmaceuticals market. At the same time, health care systems are confronted with a continuing pressure to provide high-quality care in the face of increasing costs and limited financial resources.Due to the rising pharmaceutical expenditures in the world, governments are struggling to keep costs under control [1-3]. There are valid concerns about the rationality of use of medicines, mostly as a result of inappropriate physician prescribing. Physicians’ prescribing is the most common medical intervention with a high impact on health care costs [4]. Improving and promoting rational use of medicines contributes to a more efficient use o