Cost Savings and Cost-Effectiveness of Clinical Preventive Care

It is well established that preventive care reduces the prevalence of disease and helps people live longer, healthier lives.

Medical advances have reduced the prevalence of many acute conditions, while increasing length of life. As a result, chronic disease has become the dominant cause of death in the United States. Chronic diseases are driven by risk factors, many of which can be prevented. Preventive care has the potential to control risk factors, thereby reducing the prevalence of costly chronic conditions. Many preventive clinical care services offer good value for increasingly scarce dollars.

What is Preventive Care?

Preventive care services can be divided into three categories — primary prevention, secondary prevention and tertiary prevention. Primary prevention aims to avoid the onset of disease. Examples include childhood vaccines, smoking cessation counseling and weight loss programs. Secondary prevention aims to prevent disease from developing beyond its early stages and often depends on screening. For example, mammogram screening aims to detect breast cancer when it is more likely to be amenable to treatment. Tertiary preventive measures minimize progression and symptoms associated with established disease. Examples include control of blood sugar levels in people with diabetes to prevent damage to blood vessels and organs.

Does Preventive Care Save Money?

Benefits for many preventive services come at a relatively low cost, and much preventive care is cost-effective. However, there are relatively few clinical preventive care interventions for which there is strong evidence of cost savings. For instance, prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity, and development of other ailments. Whether these additional “competing risk” costs outweigh savings from avoiding the targeted disease depends on how healthy people are during their added life years.

Economic analyses often omit the costs associated with longer life and competing risks. The omission is, in part, due to the difficulty in estimating such costs, and also to conventions established in the field of health economics. Although preventing poor health extends life, it may compress the amount of time individuals spend disabled when compared with similar individuals whose health deteriorates earlier.

Additionally, assessing cost savings associated with preventive care may depend on whether the question is asked from the perspective of the health care system, individuals or employers. Changes in health care costs affect health care system entities, like private insurance companies and public programs such as Medicare. They also affect employers that subsidize employee health insurance policies, and employees who pay for health benefits.

Costs, Benefits and Policy Implications

It is unlikely that substantial cost savings can be achieved by increasing the level of investment in clinical preventive care measures. On the other hand, research suggests that many preventive measures deliver substantial health benefits given their costs.

Moreover, while the achievement of cost savings is beneficial, it is important to keep in mind that the goal of prevention, like that of other health initiatives, is to improve health. Even those interventions that cost more than they save can still be desirable. Because health care resources are finite, however, it is useful to identify those interventions that deliver the greatest health benefits relative to their incremental costs.

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