Tuesday, August 4, 2009

Preventive care

Preventive care. Good, right? Prevent diseases from occurring in the first place instead of treating those conditions once they occur. Sure, sounds great! And it probably saves money too, right? Wrong.

While prevention makes good sense, and should happen (in most cases, anyway), prevention does not save money. (See this Kaiser article.) There are some exceptions. Childhood immunizations by and large save money, as do smoking cessation programs. But Pap smears, screening for prostate cancer, and other preventive care programs do not save money.

Many involved with health care reform mistakenly tout that these new prevention measures will save us money in the long run. That simply isn't true. Adding prostate cancer screening, for example, will cost Medicare $2.8 billion over 10 years.

Please don't misunderstand me. I am a big proponent of cost-effective preventive care. Stressing the cost-effective part. Cost-effective doesn't necessarily mean cost saving. If the intervention costs less than, say, $50,000 per life year saved, it may be deemed cost-effective. (This is an arbitrary figure that just illustrates how cost effectiveness is measured. An intervention may cost $1 per life year saved - pretty good! - or $1 million per life year saved - pretty bad! - and the cutoff point is VERY subjective.

Let's take the example of cervical cancer screening. Screening women (who have had a normal Pap smear) for cervical cancer every 3 years costs $262,800 per life year saved vesus the $1.1 million screening every year. (Russell's "Educated Guesses") Indeed, the Agency for Healthcare Research and Quality (AHRQ) does not recommend annual screening, because there is no evidence "that annual screening achieves better outcomes than screening every 3 years."

So, in sum, preventive care is not always cost-effective. Sometimes it is. Sometime it's not. But the determination of when something is cost-effective is extraordinarily subjective. Screening your mother for breast cancer may be worth $1 million to you but only $1 to someone else. It's a very tricky business.

More articles about prevention:
Health prevention often costs more than it saves
Do prevention or treatment services save money? The wrong debate
Preventive care and cost savings
Preventive care not always cost effective
Does preventive care save money?

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