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A recent article in the New England Journal of Medicine challenges the dogma that prevention always pays. This is especially important within the current presidential political environment with candidates promoting prevention as a way to stop skyrocketing health care costs. The authors note that many preventive measures do save money such as flu vaccines for seniors and fortifying cereal with folic acid. However, many others don’t save as much as they cost, for example some disease screening tests for people who are not at risk or for very rare conditions. In fact, the large majority of preventive measures that have been tested have not been found cost effective. The authors state that prevention is very valuable, but that it may not be enough to fix our health care cost problems.

In another study Dutch researchers using computer modeling of lifetime health costs, found that while obese individuals and smokers have higher average annual health costs, they consume less in health care services over their lifespan. Healthy people live 84 years on average, while obese individuals average 80 years and smokers only 77. Over their lifetime, healthy people will consume $410,000 in health care costs compared to $365,000 for obese individuals and $321,000 for smokers. While successful treatment of obese patients and smokers increases life expectancy, those years gained are not lived in full health; there is substitution of less deadly but more costly disease. The authors do not advocate that governments and other payers discontinue policies to prevent and treat smoking and obesity, but that the goal should be to improve lives, not to save money.

Posted by Ellen Andrews