When is it cost-effective to change the behavior of health professionals?
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
J
Centre for Health Services Research, University of Newcastle Upon Tyne, Newcastle Upon Tyne, England. james.mason@ncl.ac.uk
Freemantle
N
N
Nazareth
I
I
Eccles
M
M
Haines
A
A
Drummond
M
M
D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics*; D004502:Education, Medical, Continuing; D004739:England; D005252:Fees, Pharmaceutical; D017048:Health Care Costs; D006801:Humans; D010346:Patient Care Management / Q000592:standards; D011050:Policy Making; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000639:trends