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April 3, 2002

The Costs of Making Practice More Cost-effective—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

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

In Reply: There are multiple aspects to any strategy to change behavior, which may influence cost-effectiveness and vary with content, setting, country, and funding agency. We agree with Drs Weeks and Wallace that physician time-costs will influence implementation loading; from the various US funding perspectives, different costs may be included and excluded. Similarly, if implementation research involves a certain pattern of incentives and if these are changed by the funding agency, this may well affect the amount of behavioral change. For example, from a pharmaceutical industry perspective, the costs of drugs become bottom-line profits; our model offers some insight to the motivations behind its promotional activities. The inclusion of health care costs of extended healthy life (which would themselves have benefits) remains a debated issue, though routinely excluded from calculations of treatment cost-effectiveness.1,2