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.
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.
Mason J, Freemantle N, Nazareth I, Eccles M, Haines A, Drummond M. When Is It Cost-effective to Change the Behavior of Health Professionals? JAMA. 2001;286(23):2988–2992. doi:10.1001/jama.286.23.2988
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