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Does prevention pay?

Results are mixed on the cost-effectiveness of prevention

Tammy Worth, Contributor

A new report by Trust for America’s Health offers solutions to policy makers and the public to increase the amount of prevention in the healthcare system. According to the report, prevention improves health and productivity “while saving billions in health care costs.”

In this report, the authors link prevention and savings by assuming that increasing preventive services will, in turn, reduce the spending on chronic diseases, lowering overall healthcare costs. For example, they said that chronic diseases like Type 2 diabetes and heart disease are responsible for 75 percent of total U.S. medical spending.

[See also: AHA: Americans living longer but getting sicker]

While this sounds like a reasonable connection, the link between prevention and reduction in health spending is not always a direct one.

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A 2008 study by health experts from Tufts and Harvard universities found that prevention can at times save costs and others times, increase spending. In fact, their analysis of studies found that treatment and prevention are almost equally cost effective.

George Miller, an institute fellow at the Altarum Institute, said part of the challenge is with clinical preventive treatments like screening. Health screenings have to be performed on a large population – many of whom don’t have the illness. There also can be costs attributed to treating false-positive results.

“The reason it is so widely believed that prevention saves money is that it seems obvious,” he said. “It is less expensive to prevent someone from having a heart attack than to wait and treat him after. But there are a whole lot of expenditures that have to be counted and when you use those, you find that most clinical prevention doesn’t save money.”

[See also: Unhealthy behaviors impacting quality of life, costs]

But one area that evidence shows prevention may be more effective is outside of the doctor’s office. The Trust for America’s Health report focuses on environmental prevention efforts like augmenting the public health system, increasing anti-smoking activities and expanding workplace wellness efforts.

Miller said environmental prevention often decreases costs because they are focused on a targeted, at-risk population instead of blanketed across a wide range of people.  

For instance, Rich Hamburg, deputy director of Trust for America’s Health, said money can be invested in one community to do a host of things at once – put in sidewalks, allow only healthy food and snack at schools and ban smoking.

A meta-analysis of 2,815 studies in a July 2012 New England Journal of Medicine report bore Miller’s conclusion. Forty-six percent of environmental studies were found to be cost saving as opposed to 16 percent of clinical and 13 percent non-clinical, person-directed.

The results may be because of the lower expense of altering people’s environments in ways like creating smoking bans or requiring businesses to label calorie content on foods.

The authors cite the example of New York City, which increased tobacco taxes, created non-smoking laws and anti-smoking media campaigns. They said this has resulted in 450,000 fewer smokers in a decade and reduced smoking-related deaths by approximately 1,500 per year.

Additionally, a 2008 Trust for America’s Health report that found that targeted, strategic investment in “proven community-based programs to increase physical activity, improve nutrition and prevent smoking and tobacco use” could save more than $16 billion annually over five years. They estimated a return of $5.60 for every $1 spent.