A few months ago I commented on an article in the New England Journal of Medicine that questioned the cost-effectiveness of disease prevention (1). The article had the rather astonishing title "Does prevention save money?". It turned out the authors had a rather peculiar idea of prevention. They weren′t thinking of healthy eating, physical activity, smoking cessation, stress reduction etc. Instead, their main interest lay in the cost-effective use of medical diagnostics to catch diseases at their most treatable stages.

There is nothing wrong with medical tests to detect problems as early as possible, but this obviously does nothing to prevent these problems from occurring in the first place. Many of today's health problems are avoidable lifestyle diseases — think of obesity and its consequences — and one would have thought that this fact wasn′t lost on medical doctors.

Of course prevention pays, and a recent report from the Trust for America′s Health makes this very clear (2). The paper, titled "Healthier America: Investments in disease prevention yields significant savings, stronger communities", presents a detailed analysis of the kinds of savings that can be realized by relatively modest investments in practical measures:

"This study … examines how much the country could save in health care costs if we invested more in disease prevention, specifically by funding proven community-based programs that result in increased levels of physical activity, improved nutrition (both quality and quantity of food), and a reduction in smoking and other tobacco use rates." (2)

The authors based their estimated changes in disease risks, program costs and savings in treatment costs on published studies that focused on:

• prevention programs that do not require medical treatment,
• programs that target communities rather than individuals, and
• evidence-based programs that have been shown to reduce disease through improving physical activity and preventing smoking and other tobacco use in communities.

From these studies the authors concluded that an investment of $10 per person per year in proven community-based prevention programs could yield net savings in U.S. health care costs of

• more than $2.8 billion annually in 1 to 2 years,
• more than $16 billion annually within 5 years, and
• nearly $18 billion annually in 10 to 20 years.

The authors emphasize that they consider these cost savings conservative estimates. It would require 5% reductions in type 2 diabetes, high blood pressure, heart and kidney disease, and stroke, and 2.5% reductions in the incidence of some forms of cancer, chronic obstructive pulmonary disease, and arthritis. These estimates assume that any achieved improvements in health are sustained. They do not include likely savings on such factors as nursing home care, reductions in worker disability (i.e. increases in productivity), or decreases in other diseases. It would also spare millions of people unnecessary suffering.

"The nation′s economic future demands we find ways to reduce health care costs. Preventing people from getting sick is one of the most important ways we can drive costs down." (2)

And this undoubtedly holds true for other countries as well.

Sources

1. Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health econmics and the presidential candidates. N Engl J Med 2008;358(7):661-663. [Full Text]
2. Levi J et al. Healthier America: Investments in disease prevention yields significant savings, stronger communities. Trust for America′s Health. July 2008. [Full Text]