When is it cost-effective to change the behavior of health professionals?

JAMA. 2001 Dec 19;286(23):2988-92. 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Drug Costs*
  • Drug Utilization / economics*
  • Education, Medical, Continuing
  • England
  • Fees, Pharmaceutical*
  • Health Care Costs
  • Humans
  • Patient Care Management / standards
  • Policy Making
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / economics*
  • Practice Patterns, Physicians' / trends