The economic evaluation of clinical practice

This paper considers a series of questions: why economists are concerned with evaluating clinical practice; whether economic evaluation has much impact on clinical practice; possible reasons for the observed lack of impact; and the future role of evaluation. The prime reasons for the interest of economists are that the health service absorbs substantial resources and that clinicians have a major role in directing their use. Evaluations that have been carried out have had a limited impact on practice. This is because of weaknesses in the studies themselves; the widespread lack of receptivity to economic arguments found among clinicians; and the absence of incentives to encourage clinicians to be concerned with cost-effectiveness. The conclusion is drawn that major changes in clinician behaviour will not be brought about by evaluation alone. A major role for evaluation lies in educating clinicians to use economic concepts and modes of thinking in their day-to-day practice.