Measuring Prevention’s Cost Savings

Several newspaper stories have referred to a recent article published in Health Affairs as demonstrating a new way to measure the savings from preventive care and implied it could facilitate more favorable scoring of reform measures by the Congressional Budget Office.  These stories reflect a common categorical confusion about various kinds of health-related activities.  The Health Affairs article deals with management of persons with Type 2 diabetes and the impact of programs designed to slow the advance of their disease, which in itself is a very important topic. (Health Affairs article) True preventive care, however, should be thought of as measures designed to keep people from getting a disease or health condition in the first place.

Notwithstanding the definitional confusion, the Health Affairs article is a useful proposal for understanding the cost ramifications of both increased chronic disease and programs designed to manage those diseases effectively.  The researchers essentially built an epidemiological model of the number of people with the disease, their progression and the costs of treating their diabetes.  The model allows simulation of the impact of programs which slow the disease’s progression.  A similar model could likely be built for other chronic diseases.  The authors suggest that the model could be used to understand cost impacts over a longer period than the typical ten-year period used by the CBO.  In the case of Type 2 diabetes, the model indicates that there are probably no net savings from an intervention program over ten years and very modest savings over 25 years.  This is largely because of program costs and additional health costs for diabetes treatment that would result from better identification and management of the disease.  The model does not include non-diabetes related health costs or savings and does not include non-health related cost impacts, for example, more social security spending if the patients live longer, but potentially lower disability payments if they are healthier.

What always needs to be said about these attempts to understand the value of either prevention or care management programs is that they universally likely improve the health status of the patients in the programs.  That has a significant non-monetary value, particularly to the affected individuals.  It is an important issue to find ways to reduce the growth of health spending in the United States, but we should not devalue programs that may not help reach that goal, but do result in significant health improvements.