With the prevalence of stacking spell vamp/lifesteal, and with how many champs self heal through abilities, grievous wounds seems to be the best counter to keeping them dead. Tryn, ADC's, Mundo, Vlad, Yorick, Xin, etc all base their existence on how much they live just on regen/sucking health from others. All that being said...our options to STOP that insane regen from happening are extremely limited, and come out of odd builds. Avarice Blade, while good for gold generation, has no other decent stats, and what it builds into, Executioners Calling, is weak 100% outside of inflicting grievous wounds. Morellonomicon is a great all purpose AP item, but it's under utilized from I've seen, mostly because outside of support not many worry about getting Kage's (side note, I don't ever when I'm mid because I get more gold generation killing creeps with other items, i.d. needlessly large rod, Chalice, etc). I know of 2 champs who have abilities that inflict grievous wounds, Tristana's E and MF's W.

So, maybe griveous wounds is just op, but with the rash of people who can regen, and do it insanely well, it seems like maybe we could get some more item choices to apply them? Just a though.

All hail Zultan.

Actually, Executioner's Calling is more than cost efficient, even if you ignore the passive.

Ignite applies it, Varus, Fizz, Kat all have it. Morellonomicon is an amazing item and Executioner's Calling is cheap as balls and offers some fair stats for most carries or bruisers.

While I wouldn't object to some more healing reduction items, I would object to too many healing reduction items. What we have now is perfectly serviceable and overdoing it would warp the meta against healing immensely.

While it may be cost efficient, it still take an item slot from you, that could have held an item with much more stats. Both Phantom Dancer and Dagger are cost efficient, but which of them would you like to stack 6 of?

Dagger. I could use them to build useful items instead of wasting all that crit from 6 PDs.

To expand upon that, simply because I'm bored;

Berserker's Greaves
BotRK
Zephyr
Trinity Force
Statikk Shiv
Phantom Dancers

Just one possibility.

If you ignore the passive and compare it to Long Swords and Brawler's Gloves, it offers 2000 gold worth of stats for 1900 gold. If you compare it's raw stats to B.F. Sword and Cloak of Agility, it offers 1835 gold worth of stats for 1900 gold.

Which isn't more than cost efficient when you ignore the passive - it costs pretty much exactly the same as what it's stats give you when you ignore the passive. Beyond that it's redundant with Infinity Edge, costs a really awkward amount without doing anything particularly useful, and forces you to auto-attack champions like Mundo and Volibear for it's passive to do much of anything - which is all around a horrible idea in the first place under most circumstances, and has to compete with other items that do generally offer a lot for even more effective cost-efficiency.

a better item is to have an unique effect that steals the open Lifesteal/ spell vamp over time. such as this per on hit you steal up to 5% per hit. Thus does the effect but really doesnt hurt healing just stats wise.

So you can just say trynmere stop getting BT or i will run that off of you.

1. Rework the unique to only apply on champs below 40-50% hp.
2. Lengthen the wound to 3 secs.
3. Make it apply based on any physical damage instead of basics.
4. Make the final combination avarice + brutalizer.

Tell me you wouldn't buy it...

It simply needs the Hex Drinker rework. Remember that other item no-one used in season 2, and is now actually useful? Simply lower the stats and cost, slap on another item like brutaliser or zeal, and make them into a late-game item.
Also, "Make it apply based on any physical damage instead of basics.", thats a bit too far. Not everything needs to copy other items, it does its passive well enough on basic attacks, let alone for a full 8 seconds after draven attacks you because his passive keeps proccing it..