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April 3, 2002

The Costs of Making Practice More Cost-effective

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(13):1648-1650. doi:10.1001/jama.287.13.1645

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.

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