By comparison, only 50 people with heart disease must be treated with aspirin for one to avoid a heart attack or stroke, making this a good buy.
The numbers of people who need to be treated for one to benefit are so high because so few will get the disease the preventive is meant to avert. It's like treating every house for termites, said Neumann, co-author of the Robert Wood Johnson report: The vast majority would never have gotten infested in the first place, so the thousands spent to avoid the infestation is money for nothing.
MAKING HEALTHCARE DOLLARS GO FURTHER
A better gauge of the value of preventive medicine is bang for the buck; that is, not whether it reduces healthcare spending but whether it buys more health than treating the disease does. "We don't ask whether cancer treatment or heart disease treatment saves money," said Dr. Steven Woolf, professor of family medicine at Virginia Commonwealth University Medical Center in Richmond. "But it is reasonable to ask how to make our healthcare dollar go further."
On that score, screening for hypertension and for some cancers (such as colorectal and breast) are good investments, he said, at less than $25,000 per year of healthy life. In contrast, such common treatments as angioplasty cost $100,000 or more per healthy year of life.
There are two glimmers of hope in this bleak picture. For preventive medicine to help rein in the nation's soaring healthcare spending, it should be provided someplace other than doctors' offices.
"Some of the most common chronic, preventable diseases might be best addressed outside the clinical setting," said the Trust's Levi, such as through wellness programs at YMCAs and health education and screening programs at houses of worship. "But that requires Medicaid to be more flexible in who they'll reimburse."
It also requires a more expansive definition of preventive medicine. The Trust suggests such steps as extending bus lines to parks so people without cars can go someplace pleasant for physical activity and other "community-based" efforts. These strategies save more money in healthcare spending than they cost.
For instance, at a program in Akron, Ohio, profiled in the new report, physicians and others coordinate care for patients with Type 2 diabetes. It reduced the average cost of care by more than 10 percent, or $3,185 per year, largely by reducing pricey emergency-room visits.
And at Boston Children's Hospital, an asthma program that sends community health workers into patients' homes to reduce the environmental triggers of asthma has saved $1.46 in healthcare costs for every $1 invested. It has reduced asthma-related hospital admissions by 80 percent and asthma-related emergency department visits by 60 percent, reports the Trust.
The other promising approach is to target preventive care at those most likely to develop a chronic disease, not at low-risk people. Such "smart" prevention increases the chances of preventing expensive diseases and saving money.
In contrast, unthinking expansion of preventive medicine is the wrong prescription, say experts.
"If you start giving preventive care to more people, many of whom won't benefit from it, it's going to be very, very expensive," said Tufts' Neumann.
(Editing by Jilian Mincer and Douglas Royalty)
Think preventive medicine will save money? Think again
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