Prevention - As Good as it Sounds?

Prevention sounds good. An ounce of prevention is, after all, worth a pound of cure. All one needs to do is stop smoking , exercise, eat fruits and vegetables, lose weight, and get periodic preventive screening tests. But does it save money?


But prevention sometimes may be the reverse of what Mark Twain said of Richard Wagner’s music, “It’s not as bad as it sounds.” Prevention may not be as good as it sounds when it come to saving money.


It depends on what type of prevention you are talking about. Keep this in mind when current presidential candidates talk of prevention as the best, least costly way to save money.


Here is what the candidates are saying.


• Hillary Clinton. “Focus on prevention: wellness not sickness.”


• Barack Obama, “Too little is spent on prevention and public health.”


• Mike Huckabee, who lost 100 pounds on his own, “Prevention would save countless lives, pain and suffering by the victims of chronic conditions, and billions of dollars.”


These sound bites sound good and are hard to disagree with. . But a few snags loom. Most doctors are not paid for preventive counseling. And even when doctors devote a few precious moments to preventive talk, patients may forget and lapse into their former life styles. Lastly, depending on program, some intensive preventive programs may cost money and worsen health.


Three Boston academics have analyzed the cost of prevention. In “Does Preventive Care Save Money? Health Economics and the Presidential Candidate,” the authors studied 599 articles and 1500 cost-effective ratios in terms of QALYs (Quality Adjusted Life-Years). Low ratios are “favorable,” indicating QALYs can be accrued inexpensively, i.e. costs are saved while improving health.


Here are a few of their findings.


• H. influenzae type b vaccinations cost-saving
For toddlers

• One time colonoscopies for men cost-saving
aged 60-64

• Family intervention for Alzhemiers cost–saving

• Cochlear implants for deaf children cost-saving

• High intensity smoking relapse $160/QALY
programs compared to low intensity
programs

• Intensive tobacco-use prevention, $190/QALY
Compared to low-intensity

• Intensive tobacco use prevention $2300/QALY
For 7th and 8th graders

• Left-vent. assistance device, $900,000/QALY
compared to intensive medical Rx

• Amoxicillin for kids with heart increases cost,
disease undergoing urinary caths worsens health

• Surgery in 70 y.o for new diagnosis increases cost
of prostate ca compared to watchful worsens health
waiting

An ounce of prevention, in other words, is not always worth a dollar of cure.

Reference

J T Cohen, P.J. Neumann, M.C. Weinstein, “Does Preventive Care Save Money? Health Economics and the Presidential Candidates, NEJM, 358:661-663, February 14, 2008