Upon reading my CJO column today about the three markers of superficial health policy, a reader sent along this story from last week’s Washington Post offering a similar take on the myth of prevention as a cost-saving reform. I highly recommend the piece. A key passage:
There are many reasons prevention usually doesn’t save money.
Perhaps the most important is that prevention activities target many
more people than will ever come down with the disease being prevented.
The reason (thankfully) is that people tend to stay healthy for most of
their lives, no matter what they do.
Take the example of lowering cholesterol to prevent heart attacks.
The vocabulary of cardiac risk uses such terms as “normal,” “high”
and “very high.” But in reality, most people even in the “very high”
risk category don’t suffer heart attacks over quite long time horizons.
Consider a 50-year-old male smoker whose total cholesterol is in the
“high” range (over 240); whose HDL, or desirable cholesterol fraction,
is “low” (below 40); and who has untreated moderate hypertension.
Sounds like a walking time bomb!
It turns out his chance of having a heart attack in the next 10
years is only 25 percent. For a woman with the same profile, the chance
of having a heart attack is 11 percent. Almost nine out of 10 such
people will dodge the bullet by . . . doing nothing.
And this:
Prevention can be expensive even when it doesn’t involve taking drugs
or undergoing procedures. Even giving information can be uneconomical.
That’s because giving information takes time, and the yield in terms of
behavior change that leads to less disease is very low — as anyone who
has been told to eat less and exercise more knows.
For example, Australian researchers tried out a program in which
general practitioners watched a video and read a booklet about how to
help their patients lower their heart attack risk. The patients were
then given a series of videos and a self-help booklet on the same
topic.
How cost-effective is this instruction? When it is provided for
women at low risk of heart disease, $9.8 million has to be spent for
every year of life saved in the prevention of premature heart attack
deaths.
