Health Experts Clash Over 'Cost Savings' From Prevention Measures

Two health care experts provided starkly different perspectives on whether prevention measures actually save costs during a Jan. 6 forum here sponsored by the journal Health Affairs.

Louise Russell, Ph.D., a professor of health economics at Rutgers University in New Brunswick, N.J., said most prevention efforts do not result in cost savings. Her viewpoint was countered by Ron Goetzel, Ph.D., director of the Institute for Health and Productivity Studies at Emory University in Atlanta, who argued that prevention "offers a very good return on investment." Russell and Goetzel published their respective views in the January/February issue of Health Affairs.

According to Russell, prevention efforts can result in savings to the health care system, but in most cases, the savings are "outweighed by the cost of the prevention/intervention itself."

Prevention usually does not result in cost savings, said Russell. Although the "additional medical costs are sometimes minor … they can be very, very substantial as well. There are many, many medical interventions that we do routinely that cost hundreds of thousands of dollars for a life that is saved, some of them millions of dollars for a life that is saved."

Russell said there have been thousands of carefully designed cost-analysis studies conducted in the area of prevention during the past 40 years that consistently point to one conclusion: The vast majority of preventive interventions add more to medical spending than they save. For example, said Russell, the Tufts Medical Center Registry reviewed the cost-effectiveness of hundreds of treatments and prevention efforts between 2000 and 2005 and found that more than 80 percent of the prevention efforts increased medical costs rather than reduced them.

"This conclusion applies to a wide range of interventions and to the major preventive interventions that we all know about -- drugs to reduce high blood pressure, drugs to reduce high cholesterol, cancer screening tests and lifestyle changes to prevent or delay the onset of diabetes," Russell said.

Prevention efforts are aimed at the probability of a condition -- something that might happen, not something that has happened, she said. When evaluating prevention efforts, it is important to ask a few key questions, Russell contended, such as:

Although Russell said she is convinced that prevention does not save costs in most cases, she nevertheless described prevention as a worthwhile component of good medical care, noting that "for chronic conditions, as well as other health problems, our goal should be to use prevention as effectively as possible."

Goetzel responded to Russell's comments, saying that prevention and health promotion can provide high value by improving lives at a relatively low cost when compared with the expense of treatments.

"The issue relative to this debate is not whether any given prevention or treatment service saves money, but rather how much value is gained from that service," he said.

The discussion should focus on ways to achieve enhanced health care for the population and to allocate resources most effectively to "get the biggest bang for the buck," said Goetzel. He acknowledged that certain clinical preventive services do not save money. "But then again, neither do most medical treatments," Goetzel said.

Prevention efforts encompass a broad range of diverse and far-reaching initiatives, including childhood immunizations, raising taxes on cigarettes, cancer screenings and eliminating the sale of sugary beverages in schools.

"Health care spending in the United States exceeds $2 trillion a year, with three-fourths of that spending directed at treating chronic diseases," said Goetzel. "Nearly two-thirds of the growth in spending is a result of Americans' worsening health habits."

The nation's health care delivery system "favors paying for the treatment of chronic diseases rather than preventing them in the first place," he said.

"We need to improve the health of Americans and, thereby, reduce the social and financial burdens imposed by preventable diseases," Goetzel said.

Goetzel also championed workplace health promotion programs, saying that, when conducted properly, the programs reduce health care costs for companies and improve worker productivity, resulting in benefits for both employees and their employers.

That statement was supported by Brent Pawlecki, M.D., corporate medical director at Pitney Bowes, a Fortune 500 company with about 24,000 employees in the United States. During the past several years, Pitney Bowes has launched several health promotion programs that include on-site medical clinics and fitness centers. The company also has adopted infection control practices. In the past nine years, the initiatives have resulted in about $40 billion in health care savings, said Pawlecki.