There’s no doubt that as part of Obama’s healthcare reforms, we’ll be told that spending more upfront on preventative medicine will actually save us money in the long term. Indeed, preventative medicine is frequently sold as one of the great silver bullets of the whole healthcare debate.
And really, who could be against it? More, better care costing less. What’s not to like?
But of course it’s more about feeling good than any evidenced based reality.
The latest hole in the myth has to do with prostate cancer screening.
LAT: The first report, on an American study of 76,000 men, found no survival benefit from screening. The second report, on a European study of 162,000 men, found a 20% reduction in deaths — which was only barely significant statistically because of the small number of deaths on which it was based. Both reports were published online in the New England Journal of Medicine.
Even with the reduction found in the European trial, it was necessary to screen 1,400 men and treat 48 cancer cases to save one life.
“What the European study tells us is that, if you are a man who chooses screening, you are 47 times more likely to be harmed . . . than to have your life saved,” said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society.
This isn’t much of a surprise for people that have followed this. The benefits of preventative care and screening rarely match up to the hype.
Indeed an article published in the New England Journal Of Medicine back in 2006 had this to say:
Sweeping statements about the cost-saving potential of prevention,however, are overreaching. Studies have concluded that preventingillness can in some cases save money but in other cases canadd to health care costs. For example, screening costs willexceed the savings from avoided treatment in cases in whichonly a very small fraction of the population would have becomeill in the absence of preventive measures. Preventive measuresthat do not save money may or may not represent cost-effectivecare (i.e., good value for the resources expended). Whetherany preventive measure saves money or is a reasonable investmentdespite adding to costs depends entirely on the particular interventionand the specific population in question. For example, drugsused to treat high cholesterol yield much greater value forthe money if the targeted population is at high risk for coronaryheart disease, and the efficiency of cancer screening can dependheavily on both the frequency of the screening and the levelof cancer risk in the screened population.
The focus on prevention as a key source of cost savings in healthcare also sidesteps the question of whether such measures aregenerally more promising and efficient than the treatment ofexisting conditions. Researchers have found that although high-technologytreatments for existing conditions can be expensive, such measuresmay, in certain circumstances, also represent an efficient useof resources. It is important to analyse the costs and benefitsof specific interventions.