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Prevention: Russell RespondsAs the title of my Jan/Feb 09 article implies, and the article and abstract explain, a minority of preventive interventions do reduce medical spending. So do a minority of treatments. There might be more if prices were lower. A recent analysis reported that statins would be cost-saving at less than 10 cents per pill.1 Nonetheless, over the full range of effective prevention, four decades of studies show that most preventive interventions add more to medical spending than they save. Aspirin, pediatric immunizations, and smoking cessation are certainly among the most cost-effective interventions, but more-nuanced conclusions are needed. As I noted in my article, aspirin is cost-saving for men at high risk of heart disease but might not even be beneficial for women.2 Screening for tobacco use improves health only if it leads to smoking cessation. A study funded by the Agency for Healthcare Research and Quality (AHRQ) found that smoking cessation programs add a few thousand dollars to medical spending for each year of life they save—excellent value, but not cost-saving.3 I agree with Thomas Kottke and his colleagues that it is important to identify those preventive interventions, and treatments, that contribute the most to better health. If we did a better job of setting these priorities, Americans might enjoy the longer lifespans of citizens in other high-income countries, all of which spend less than we do on medical care.
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