Does Prevention Pay?

Dr. Charles recently posted over at KevinMD on the top 10 cost effective preventive medicine services.
1) Aspirin
2) Childhood Immunization
3) Smoking cessation
4) Moderating alcohol intake
5) Colorectal cancer screening
6) Hypertension screening
7) Flu immunization
8) Vision screening
9) Cervical cancer screening
10) Cholesterol screening

The exciting thing here is some of these cost effective strategies also relate to cancer and many are also on our Your Disease Risk list of the 8 best ways to prevent disease. This should seem obvious, but it is always a nice reminder that the most effective approaches for disease prevention are also often cost effective approaches.

But not always…

KevinMD also has a piece this week on a Health Affairs report showing that a diabetes management program costs slightly more overall than doing nothing over the 25 years of study. This doesn’t mean we shouldn’t manage diabetes, but it does show that cost and the best care aren’t always synonymous. Keep in mind however, a couple caveats about this report:
1) this is about the cost of diabetes management not diabetes prevention. True primary prevention is about strategies to keep the disease from ever being diagnosed (as Dr. Moore nicely notes in the comments on Kevin’s page)
2) the Health Affairs analysis focuses on the costs to Medicare as it is a follow-on on previous Congressional Budget Office reports that only examine more near-term (over 10 years) costs. That means the costs related to worker productivity, absence from work and quality-of-life aren’t included. Given the close margin in “cost” the report found, it is likely that accounting for these additional “societal” costs would make diabetes management programs cost-effective. As with all cost-effectiveness analyses, the time line and definition of costs are key to the result.

As this week’s Health Affairs notes, there are programs consumers want regardless of the cost. We seem to equate more care and more expensive care with better care regardless of the evidence for such programs being effective or cost-effective exists. Some expensive interventions are worth it, some aren’t. Some inexpensive interventions are worth it, and some aren’t. And too often, the decisions to pursue interventions or cover them isn’t based on effectiveness.

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