Evidence-based public health Preventing major illness does not save money in the long term :OMMENTAR~ Bonneux L, Barendregt J J, Nusselder W J, Van der Maas P J. Prerenthlgfatal diseases hwreases health care costs: cause elimhlation life table approach. BMJ 1997; 316:26-29 Objective To assess the cost to society of preventing fatal diseases and thereby increasing longevity. Literature review No explicit search strategy; 14 references cited. Setting The population of the Netherlands, 1988. Method The authors used a mathematical model combining life expectancy and health care costs to answer a set of 'What if?.' questions. For example, if heart disease could be prevented, would health care costs be reduced or increased, as those who would have died get older and develop other diseases? Results The average total cost of health care for men was £56 600 and for women was £80 900. Heart disease accounted for 19% of all deaths but for only 2.7% of health care costs. Preventing deaths from heart disease increased the average life expectancy of men from 73.5 years to 78.8 years. However, health care costs were calculated to increase as a result by 5.2%. A similar increase is observed when the other major killer, cancer, is 'eliminated' in this analytical model, when health care costs also rise by 3.8%. The main diseases that resulted in a reduction in eventual health care costs, if prevented, were mental health and musculoskeletal diseases, which resulted in 24.4% and 7.3% reduction respectively. These are disease categories that have a low mortality rate but incur significant costs over a long period of time. Authors' conclusions The authors conclude that 'The aim of prevention is to spare people from avoidable misery and death, not to save money on the health care system. In countries with low mortality, elimination of fatal diseases by successful prevention increases health care spending because of the medical expenses during added life years.' © ltarcourt Braceand CompanyLtd 1998 Preventative medicine is popular- the idea that we can all live free of disease, pain and mental illness appeals to the public, health care professionals and policy-makers alike. Prevention can take many forms, from government policies to reduce smoking, screening newborn children for congenital hypothyroidism, to reducing cholesterol with the new generation of expensive statin drugs. The success, cost, acceptability and benefits of all methods of prevention vary, and the recent hard lessons learned from the cervical screening program serve as a reminder to anyone who thinks preventative medicine is an easy and popular option to improve health care. This work by Bonneux et al serves to remind policy-makers and purchasers that they cannot advocate preventative medicine on the grounds that it will reduce future costs. Like every other health care intervention, preventative medicine should only be introduced vvh.en effectiveness has been proven and the implementation and quality of the service provided can be guaranteed. Otherwise we will incur costs from an unsuccessful prevention program without gaining health benefits. Dr lan Reeves Specialist Registrar Geriatrics Medicine Vale of Leven Hospital Alexandria, UK JUNE 1998 EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT 37

Preventing major illness does not save money in the long term

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Evidence-based public health

Preventing major illness does not save money in the long term

:OMMENTAR~

Bonneux L, Barendregt J J, Nusselder W J, Van der Maas P J. Prerenthlgfatal diseases hwreases health care costs: cause elimhlation life table approach. BMJ 1997; 316:26-29

Objective

To assess the cost to society of preventing fatal diseases and thereby increasing longevity.

Li terature review

No explicit search strategy; 14 references cited.

Setting

The population of the Netherlands, 1988.

Method

The authors used a mathematical model combining life expectancy and health care costs to answer a set of 'What if?.' questions. For example, if heart disease could be prevented, would health care costs be reduced or increased, as those who would have died get older and develop other diseases?

Results

The average total cost of health care for men was £56 600 and for women was £80 900. Heart disease accounted for 19% of all

deaths but for only 2.7% of health care costs. Preventing deaths from heart disease increased the average life expectancy of men from 73.5 years to 78.8 years. However, health care costs were calculated to increase as a result by 5.2%.

A similar increase is observed when the other major killer, cancer, is 'eliminated' in this analytical model, when health care costs also rise by 3.8%. The main diseases that resulted in a reduction in eventual health care costs, if prevented, were mental health and musculoskeletal diseases, which resulted in 24.4% and 7.3% reduction respectively. These are disease categories that have a low mortality rate but incur significant costs over a long period of time.

Authors ' conclusions

The authors conclude that 'The aim of prevention is to spare people from avoidable misery and death, not to save money on the health care system. In countries with low mortality, elimination of fatal diseases by successful prevention increases health care spending because of the medical expenses during added life years.'

Preventative medicine is popu la r - the idea that we can all live free of disease, pain and mental illness appeals to the public, health care professionals and policy-makers alike. Prevention can take many forms, from government policies to reduce smoking, screening newborn children for congenital hypothyroidism, to reducing cholesterol wi th the new generation of expensive statin drugs. The success, cost, acceptability and benefits o f all methods of prevention vary, and the recent hard lessons learned from the cervical screening program serve as a reminder to anyone who thinks preventative medicine is an easy and popular opt ion to improve health care.

This work by Bonneux et al serves to remind policy-makers and purchasers that they cannot advocate preventative medicine on the grounds that it wil l reduce future costs. Like every other health care intervention, preventative medicine should only be introduced vvh.en effectiveness has been proven and the implementat ion and quality of the service provided can be guaranteed. Otherwise we wil l incur costs f rom an unsuccessful prevention program wi thout gaining health benefits.

Dr lan Reeves Specialist Registrar Geriatrics Medicine

Vale of Leven Hospital Alexandria, UK

JUNE 1998 EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT 37