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Geoffrey F. Joyce, Emmett B. Keeler, Baoping Shang, and Dana P. Goldman, The Lifetime Burden Of Chronic Disease Among The Elderly, Health Affairs Web Exclusive, September 26, 2005 [Abstract] [PDF] [HTML Version][Technical Appendix 1] [Reprints & Permissions]

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Does Preventing Chronic Disease in the Elderly Lead to Cost Savings?

Afschin Gandjour   ( 4 November 2005 )

Does Preventing Chronic Disease in the Elderly Lead to Cost Savings? 4 November 2005
Afschin Gandjour, Lecturer Institute of Health Economics and Clinical Epidemiology, University of Cologne Send comment to journal: Re: Does Preventing Chronic Disease in the Elderly Lead to Cost Savings? afschin.gandjour{at}uk-koeln.de Afschin Gandjour	Geoffrey Joyce and colleagues show that Medicare will realize moderate cost savings if Medicare beneficiaries at age 65 remain free of chronic disease. The result holds even if beneficiaries develop chronic disease in subsequent years. Readers, however, might mistakenly infer from this finding that preventing chronic disease results in moderate savings. This conclusion is questionable because the analysis by Dr. Joyce and colleagues focused exclusively on Medicare expenditures and thus did not include any expenditures before the age of 65, including those for preventive services. Costs of preventive services, however, may easily exceed the savings from avoiding chronic disease at age 65. Consider, for example, antihypertensive treatment to avoid strokes and myocardial infarction. Treating 1,000 high-risk patients with 10 mg ramipril for 4.5 years prevents 20 myocardial infarctions and 11 strokes (1). At a cost of $1 per patient per day, total antihypertensive costs amount to $1.6 million (2) while lifetime savings run at only $320,000 (3). Even consideration of other antihypertensive effects such as the prevention of congestive heart failure is unlikely to change the conclusion that preventing chronic disease at age 65 does not save US health care dollars. Notes 1. S. Yusuf, P. Sleight, J. Pogue, J. Bosch, R. Davies, and G. Dagenais, "Effects of an Angiotensin-converting-enzyme Inhibitor, Ramipril, on Cardiovascular Events in High-risk Patients," New England Journal of Medicine 342, no. 3 (2000): 145-153; S. Yusuf, J. Bosch, and P. Sleight, "Preventing Stroke with Ramipril--Authors' Reply," British Medical Journal 326, no. 7379 (2003): 52. 2. $1 x 365 days x 4.5 years x 1,000 patients 3. $13,737 x 20 + $3,807 x 11. This estimate is rather conservative because in patients below the age of 65, antihypertensives were less effective.