Living Healthy Isn’t Cost Saving, It’s Cost Effective

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There are a lot of good reasons for people to lose weight and to quit smoking. However, according to a new study published in PLoS Medicine, saving money on lifetime healthcare costs isn’t one of them [1].

Researchers at the Netherlands’ National Institute for Public Health and the Environment used a simulation model to estimate lifetime healthcare costs for a hypothetical group of 1000 healthy-living people from age 20 until the time when the model predicted all had died. They made similar estimations for a group of people who were either obese (i.e. BMI > 30) or lifetime smokers with healthy weight. Healthcare costs from each group were then compared to the healthy-living cohort. Data from the Netherlands on the costs of illness was used by the mathematical model to estimate healthcare expenditures.

Perhaps not surprisingly, the model predicted that, until age 56, yearly healthcare costs were lowest for healthy people and highest for people who were obese. At older ages, smokers incurred the highest yearly costs of healthcare. However, due to differences in life expectancy (at age 20, life expectancy was 5 years less for people who were obese and 8 years less for people who were smokers), total lifetime healthcare spending was greatest for healthy people. The cost of nursing home care was the principle factor increasing the cost of care for healthy-living people.

Thus, strictly in terms of healthcare costs, prevention of obesity and smoking does not result in a cost savings, since people who are obese or are lifetime smokers are more likely to die earlier than healthy-living people.

It’s important to stress that the study focused exclusively on healthcare costs related to obesity and smoking. The study didn’t take into account other associated economic costs, such as reduced productivity or prescription drugs. Indeed, the authors suggest that, in the case of obesity and smoking, indirect costs and could be higher than direct medical expenses.

More to the point however, does the prevention of obesity and smoking require an economic savings in order to be appealing?

Not necessarily. The goal of healthcare isn’t to save money, but to reduce suffering and death. The Netherlands’ study concludes by stating that:

Prevention may therefore not be a cure for increasing expenditures — instead it may well be a cost-effective cure for much morbidity and mortality and, importantly, contribute to the health of nations.

To be cost effective, prevention has to produce optimum results for the expenditure. Specifically in healthcare, cost effectiveness is defined as the costs incurred as a result of a service divided by the health outcomes achieved [2].

Thus, review of cost-effectiveness is very useful for assessing value. Cost-effectiveness analysis should help improve the delivery of those preventive services that will lead to the greatest improvements in population health and the most efficient distribution of resources.

A 2006 study by the National Commission on Prevention Priorities identified the most valuable clinical preventative services that can be offered in medical practice [3]. The highest ranking services in terms of clinically preventable burden and cost effectiveness were:

Discussing the benefits/harms of daily aspirin use for the prevention of cardiovascular events with men >40, women >50, and others at increased risk.
Immunizing children against diphtheria, tetanus, pertussis, measles, mumps, rubella, inactivated polio virus, Haemophilus influenzae type b, hepatitis B, varicella, pneumococcal conjugate and influenza.
Screening adults for tobacco use, providing brief counseling and offering pharmacotherapy.
Immunizing adults aged >50 against influenza annually.
Immunizing adults aged >65 against pneumococcal disease.
Screening women who have been sexually active and have a cervix within 3 years of onset of sexual activity or age 21 routinely with Pap smears.
Screening adults aged >50 years routinely with colonoscopy.
Screening adults aged >65 routinely for diminished sharpness of vision.
Measuring blood pressure routinely in all adults (hypertension screening) and treating with antihypertensive medication to prevent incidence of cardiovascular disease.
Screening routinely for lipid disorders among men aged >35 and women aged >45 (cholesterol screening) and treating with lipid-lowering drugs to prevent the incidence of cardiovascular disease.
Screening adults routinely to identify those whose alcohol use places them at increased risk and providing brief counseling with follow-up.

The take-home message? Very few preventive healthcare services save more money than the cost incurred. The value of healthy-living is reduced yearly healthcare costs earlier in life and increased life expectancy. Isn’t that what it’s all about?

References

van Baal et al. Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure. PLoS Med. 2008 Feb;5(2):e29. DOI: 10.1371/journal.pmed.0050029
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Haddix A, Teutsch SM, Corso PS. Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. 2nd ed. New York: Oxford University Press; 2003.
Maciosek et al. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006 Jul;31(1):52-61.
View abstract