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.