Last week, I stated that prevention very seldom led to direct cost savings:
Some prevention efforts may lead to higher net costs (however we have determined them). And that can be okay if we think that the improved health is worthwhile. Prevention is mainly about preventing bad outcomes and not about saving money. Saving money sometimes is an intended goal but the goal of improving mortality or quality of life even at a net increase in expense is also a legitimate goal.
Prevention should be judged on what it is seeking to be doing instead of expecting it to prevent disease and other negative outcomes while also saving money.
This week a great paper in Health Affairs came out by Cutler et al that shows a massive exception case. Preventative services for cardiac diseases for Medicare beneficiaries improves mortality and lowers costs:
Decomposing spending by condition, we found that half of the spending slowdown was attributable to slower growth in spending for cardiovascular diseases. Spending growth also slowed for dementia, renal and genitourinary diseases, and aftercare for people with acute illnesses. Using estimates from the medical literature of the impact of pharmaceuticals on acute disease, we found that roughly half of the reduction in major cardiovascular events was attributable to medications controlling cardiovascular risk factors. Despite this substantial cost-saving improvement in cardiovascular health, additional opportunities remain to lower spending through disease prevention and control.
A lot is going on. Half of the cardiovascular savings were due to the prolific prescription of effective risk management drugs. These drugs have become increasing affordable over time for several reasons.
1) Medicare Part D made drugs more affordable over time
2) Quite a few of the first generation drug classes went off patent with significant generic introduction
3) Continued push by providers for prevention
There is still a lot of space for improvement as the low cost generics are still very low cost but not prescribed to every one who is at elevated risk.
There may be a few other areas where the combination of effective prevention treatments with very low costs after a reasonable number needed to treat (NNT).