Prevention Efforts Can Increase Overall Health Care Costs, Washington Post Reports

Main Category: Public Health
Article Date: 09 Apr 2008 - 8:00 PDT

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The Washington Post on Tuesday examined how the overall cost to the health care system typically increases "when lots of disease-preventing strategies are put into practice." According to the Post, "This is a seemingly illogical truth" because most people "naturally assume that preventing a disease is cheaper than waiting for the disease to appear and then treating it" -- a "belief especially dear to politicians, who often view prevention as an underused weapon in the battle against health care costs."

The Post notes that Democratic presidential candidate Sen. Hillary Rodham Clinton's (N.Y.) Web site says her health care plan is "targeting the drivers of health care costs, including our back-ended coverage of health care that gives short shrift to prevention." Democratic candidate Sen. Barack Obama (Ill.) has said "improving prevention and management of chronic conditions" is one of five cost-containment strategies that could help families save as much as $2,500 annually. Presumptive Republican nominee Sen. John McCain (Ariz.) has not advocated for prevention measures to control health care costs, according to the Post.

The Post reports that "there are many reasons prevention usually doesn't save money," but "[p]erhaps the most important" is that preventive measures target many more people than would ever develop the disease being prevented. The Post cites 50-year-old male smokers whose total cholesterol is "high," whose HDL -- or "bad" -- cholesterol is low and who have untreated hypertension. Even though these men have about a 25% chance of having a heart attack within 10 years, all of them would be prescribed statins to prevent a heart attack. Such a treatment would cost $160,000 per year of life saved by the drugs. For women with similar health statistics, who would have a one-in-nine chance of a heart attack, statins would cost $240,000 for each year added to their lives.

Prevention also can be "uneconomical" even when it does not include prescribing drugs or performing medical procedures. For example, providing preventive information to patients can be time intensive and the "yield in terms of behavior change that leads to less disease" is very low, according to the Post.

The Post reports that there are some prevention measures that reduce costs, but they are "relatively rare." Childhood vaccinations are "classic examples" of such prevention measures, according to the Post. There also are "times when prevention is the economical choice," despite an increase in total health care spending, the Post reports. For example, most smokers will live to age 70 without dying as a result of smoking. A 2002 study by British researchers showed that counseling, a nicotine replacement drug and the anti-craving drug buproprion can save one year of patients' lives for every $1,300 spent, "an incredible bargain," according to the Post (Brown, Washington Post, 4/8).

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