Cost-effective prescribing principles MCQs With Answer

Introduction: Cost-effective prescribing principles MCQs With Answer is a focused question set designed for M.Pharm students to deepen understanding of prescribing strategies that maximize patient outcomes while minimizing unnecessary expenditure. This collection explores core concepts such as pharmacoeconomic methods, generic and essential-medicine use, therapeutic substitution, formularies, drug selection (P-drug), stewardship, and practical tools like QALYs and ICER. Each MCQ challenges students to apply theory to realistic choices, emphasizing evidence-based, patient-centered decision-making, procurement implications, and safety considerations that affect overall health-system costs. Use these questions for self-assessment, exam preparation, or classroom discussion to strengthen competence in quality, economical prescribing.

Q1. Which statement best describes the primary aim of cost-effective prescribing?

• Maximize health outcomes delivered per unit of cost
• Minimize direct drug expenditure regardless of outcomes
• Always prescribe the newest and most advanced drugs
• Avoid generic medicines in favour of brand names

Correct Answer: Maximize health outcomes delivered per unit of cost

Q2. Which principle most accurately captures the ideal approach to cost-effective prescribing?

• Evidence-based, patient-centered, and economically efficient prescribing
• Choosing the cheapest available product irrespective of evidence
• Following marketing materials from pharmaceutical companies
• Prescribing based solely on physician familiarity and habit

Correct Answer: Evidence-based, patient-centered, and economically efficient prescribing

Q3. Which pharmacoeconomic analysis is appropriate when two interventions produce proven equivalent clinical outcomes?

• Cost-minimization analysis
• Cost-utility analysis
• Cost-effectiveness analysis
• Cost-benefit analysis

Correct Answer: Cost-minimization analysis

Q4. What does ICER stand for in health economic evaluation?

• Incremental cost-effectiveness ratio
• Integrated cost-efficacy report
• Internal cost evaluation rate
• Index of clinical economic return

Correct Answer: Incremental cost-effectiveness ratio

Q5. Which metric is primarily used in cost-utility analysis to combine length and quality of life?

• Quality-adjusted life year (QALY)
• Disability-adjusted life year (DALY)
• Life-years gained (LYG)
• Net monetary benefit (NMB)

Correct Answer: Quality-adjusted life year (QALY)

Q6. What is the main role of an Essential Medicines List (EML) in cost-effective prescribing?

• Ensure availability of safe, effective and cost-effective medicines
• Mandate brand-name prescribing for all therapies
• Promote experimental therapies regardless of cost
• Discourage use of generics and biosimilars

Correct Answer: Ensure availability of safe, effective and cost-effective medicines

Q7. Which of the following is a major benefit of prescribing by International Nonproprietary Name (INN) or generic name?

• Reduces cost and improves accessibility while maintaining therapeutic equivalence
• Guarantees superior efficacy compared with branded products
• Makes pharmacovigilance impossible
• Limits options for procurement and tendering

Correct Answer: Reduces cost and improves accessibility while maintaining therapeutic equivalence

Q8. What does therapeutic substitution mean in a formulary-managed setting?

• Replacing a prescribed drug with a different chemical entity that is therapeutically equivalent
• Switching to higher-cost branded medicines only
• Administering two drugs together to boost efficacy
• Stopping treatment without providing an alternative

Correct Answer: Replacing a prescribed drug with a different chemical entity that is therapeutically equivalent

Q9. Which function best describes the purpose of a hospital or national formulary in promoting cost-effective prescribing?

• Promote evidence-based, safe and cost-effective selection and procurement of medicines
• Require prescribers to use only the newest agents regardless of evidence
• Prioritize high-cost specialty drugs over essential medicines
• Abolish protocols and allow unrestricted promotional influence

Correct Answer: Promote evidence-based, safe and cost-effective selection and procurement of medicines

Q10. What is a Drug and Therapeutics Committee (DTC) primarily responsible for?

• Multidisciplinary oversight of rational, safe and cost-effective medicine use in an institution
• Representing pharmaceutical companies in prescribing decisions
• Approving all individual prescriptions before dispensing
• Handling only hospital billing issues and not clinical matters

Correct Answer: Multidisciplinary oversight of rational, safe and cost-effective medicine use in an institution

Q11. Commonly used benchmark for a cost-effectiveness threshold per QALY is often linked to:

• Country’s GDP per capita or a multiple thereof as a willingness-to-pay threshold
• The wholesale price of the most expensive drug available
• The average cost of hospital stay per patient
• Number of prescribers in a hospital

Correct Answer: Country’s GDP per capita or a multiple thereof as a willingness-to-pay threshold

Q12. What is step therapy (fail-first policy) in managed prescribing?

• Requiring trial of a lower-cost, evidence-based therapy before authorizing a higher-cost alternative
• Automatically prescribing the latest biologic for all patients
• Providing unlimited access to all branded medicines
• Randomizing patients to different treatments without consent

Correct Answer: Requiring trial of a lower-cost, evidence-based therapy before authorizing a higher-cost alternative

Q13. What is a major limitation of cost-minimization analysis?

• It requires proven equivalence in clinical outcomes between comparators
• It always accounts for patient quality of life
• It can be used when outcomes differ substantially
• It provides information on patient preferences

Correct Answer: It requires proven equivalence in clinical outcomes between comparators

Q14. Which scenario best illustrates a prescribing cascade?

• A patient given a diuretic develops gout and is then prescribed colchicine to treat the gout
• A patient stops all medicines to avoid side effects
• Two equivalent generics are substituted at the pharmacy
• A prescriber reduces dose due to renal impairment

Correct Answer: A patient given a diuretic develops gout and is then prescribed colchicine to treat the gout

Q15. What do bioequivalence studies primarily demonstrate for generic oral products?

• Similar rate and extent of absorption compared with the reference product
• Identical inactive ingredients to the originator product
• Lower manufacturing costs compared with the originator
• Improved patient adherence automatically

Correct Answer: Similar rate and extent of absorption compared with the reference product

Q16. The P-drug concept taught in rational prescribing stands for:

• Personal selection of preferred drugs based on efficacy, safety, cost and suitability
• Pharmaceutical company–driven prescribing
• Prescription-only dangerous drugs policy
• Price-driven selection irrespective of clinical evidence

Correct Answer: Personal selection of preferred drugs based on efficacy, safety, cost and suitability

Q17. Which is a recognized disadvantage of fixed-dose combinations (FDCs) from a cost-effective prescribing perspective?

• Dose inflexibility and potential inappropriate use that limit individualized therapy
• Improved patient adherence compared with multiple pills
• Lower per-tablet manufacturing and packaging costs
• Synergistic efficacy when both agents are needed

Correct Answer: Dose inflexibility and potential inappropriate use that limit individualized therapy

Q18. Why is pharmacovigilance important for cost-effective prescribing?

• It detects adverse drug reactions and safety signals that prevent costly morbidity and optimize therapy
• It increases medication costs by encouraging more monitoring tests
• It primarily promotes newer high-cost medicines
• It restricts reporting to only serious adverse events and ignores common reactions

Correct Answer: It detects adverse drug reactions and safety signals that prevent costly morbidity and optimize therapy

Q19. Which of the following is a WHO prescribing indicator used to monitor rational use of medicines?

• Average number of medicines prescribed per encounter
• National drug expenditure per capita in USD
• Number of pharmaceutical companies in a country
• Proportion of hospitals with electronic health records

Correct Answer: Average number of medicines prescribed per encounter

Q20. Which practice is most effective in reducing inappropriate polypharmacy in older adults?

• Regular structured medication review and proactive deprescribing when clinically indicated
• Automatically increasing the number of preventive medications
• Switching all drugs to high-cost branded equivalents
• Avoiding any changes to long-term prescriptions to prevent disruption

Correct Answer: Regular structured medication review and proactive deprescribing when clinically indicated

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