Yes, Prevention is Cheaper Than Treatment

Even if this analysis were true--and there are several fallacies in his calculations--it ignores the fact that most people can significantly lower their cholesterol levels and blood pressure by making comprehensive lifestyle changes that are free rather than by taking a lifetime of drugs that are costly. In our research, we found that improved nutrition, moderate exercise, stress-management techniques and social support caused a 40 percent average reduction in harmful LDL-cholesterol levels in men and women during the course of a year without drugs. Last year, more than $20 billion was spent in this country on cholesterol-lowering drugs, so the potential cost savings would be significant if more people made comprehensive lifestyle changes in lieu of drugs.

A similar but somewhat more balanced perspective was published two months ago in The New England Journal of Medicine. The authors wrote, "Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs ... In general, whether a particular preventive measure represents good value or poor value depends on factors such as the population targeted, with measures targeting higher-risk populations typically being the most efficient."

I agree that cost savings can be greatest and can be seen most quickly in those who are at highest risk or who have chronic diseases. For example, my colleagues and I at the nonprofit PMRI conducted a demonstration project in collaboration with eight hospitals to determine if comprehensive lifestyle changes could be a safe and effective alternative to bypass surgery or angioplasty in those who were eligible to receive it. After one year, almost 80 percent of people were able to safely avoid heart surgery or angioplasty, and Mutual of Omaha calculated saving almost $30,000 per patient in the first year. In a second demonstration project with Highmark Blue Cross Blue Shield, these comprehensive lifestyle changes reduced total health-care costs in those with coronary heart disease by 50 percent after only one year and by an additional 20 percent to 30 percent when compared to a matched control group.

The rapid growth of companies offering personalized genetic testing such as Navigenics, 23&Me and deCODE Genetics, makes it possible to identify people who are at highest risk for chronic disease and to tailor prevention prescriptions to those who most need it. Finding out you're at higher risk for illnesses such as heart disease or diabetes is a powerful motivator for making comprehensive lifestyle changes. Also, those at high risk are more likely to show cost savings from prevention. A Senate bill that would prohibit discrimination based on genetic information is expected to pass this week, so the use of genetic testing is likely to escalate.

Prevention is also cost-effective in healthier people, although the cost savings per person are not as high. For example, three years ago, Steve Burd, the CEO of Safeway, realized that health-care costs for his employees were rising past Safeway's net income--clearly, not sustainable. We discussed redesigning the corporate health plan for his employees in ways that emphasized prevention and wellness, provided incentives for healthful behaviors, and paid 100 percent of the costs of preventive care. Overall health-care costs decreased by 15 percent in the first year and have remained flat since then. Many other worksite wellness programs have shown cost savings, as well as a happier and more productive workforce.

In each of these studies, significant savings occurred in the first year--medically effective and cost-effective. Why? Because there is a growing body of scientific evidence showing how much more dynamic our bodies are than had previously been believed.