Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: Dr Mason and colleagues1 provide a useful framework for assessing the cost-effectiveness
of quality improvement efforts. However, this model has several potential
limitations as a tool for decision-making policy.
Many interventions, such as academic detailing and drug utilization
review, may result in greater improvements than Mason et al estimated.2,3 More importantly, quality improvement
interventions may have benefits that are not immediately quantifiable. By
promoting a culture of quality improvement, interventions in one area may
contribute to better care in other domains. Moreover, this framework does
not account for individual and social benefits that are not easily measured
in monetary value. These may include the effects of disease treatment on quality-of-life,
the spread and resistance of communicable pathogens, and the social value
that is placed on certain diseases. Explicit evaluations of cost-effectiveness
are important, but are only one of several factors needed to make rational
and compassionate policy decisions.
Steinman MA. The Costs of Making Practice More Cost-effective. JAMA. 2002;287(13):1648-1650. doi:10.1001/jama.287.13.1645