TOP 5 YEAR IN RESEARCH ARTICLE FOR 2009

This commentary examines economic arguments for disease prevention services. The author argues that the traditional framework of justifying preventive health services by their capacity to lower overall costs of health care is flawed. Instead, preventive care should be assessed by whether it provides high value for its cost. While services that reliably produce net savings are rare in health care, many preventive services improve health at a lower cost than other medical interventions.

Key Findings:

• The cost-effectiveness of health services can be examined by their cost per quality-adjusted life year (QALY). Of 25 evidence-based preventive services examined, 15 cost less than $35,000 per QALY, while a major medical intervention such as an angioplasty can cost over $100,000 per QALY.
• Several core sets of preventive services have proven to be cost-effective, including clinical preventive services such as immunizations and screening tests, and behavioral interventions to lower rates of smoking and obesity. Preventive services that offer net savings include childhood immunizations, smoking cessation, and aspirin use by patients at risk for cardiovascular disease.
• Community preventive interventions, including seatbelt requirements, taxes on tobacco, and immunization requirements, can be both more effective and cheaper than clinical preventive services.

In light of the current financial crisis, both preventive services and disease treatments must be examined in order to promote services that provide the most value for their cost.