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Special Communication
December 19, 2001

When Is It Cost-effective to Change the Behavior of Health Professionals?

Author Affiliations

Author Affiliations: Centre for Health Services Research, University of Newcastle Upon Tyne (Drs Mason and Eccles); Department of Primary Care and General Practice, University of Birmingham, Edgbaston (Dr Freemantle); Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London (Dr Nazareth); London School of Hygiene and Tropical Medicine, London (Dr Haines); and Centre for Health Economics, University of York (Dr Drummond), England.

JAMA. 2001;286(23):2988-2992. doi:10.1001/jama.286.23.2988

Because of the workings of health care systems, new, important, and cost-effective treatments sometimes do not become routine care while well-marketed products of equivocal value achieve widespread adoption. Should policymakers attempt to influence clinical behavior and correct for these inefficiencies? Implementation methods achieve a certain level of behavioral change but cost money to enact. These factors can be combined with the cost-effectiveness of treatments to estimate an overall policy cost-effectiveness. In general, policy cost-effectiveness is always less attractive than treatment cost-effectiveness. Consequently trying to improve the uptake of underused cost-effective care or reduce the overuse of new and expensive treatments may not always make economic sense. In this article, we present a method for calculating policy cost-effectiveness and illustrate it with examples from a recent trial, conducted during 1997 and 1998, of educational outreach by community pharmacists to influence physician prescribing in England.