Prevention Myths

Preventive care saves money.

Wrong; wrong and...wrong!

This has been pointed out over and over in the blogosphere and other places in the media. It is not true. Prevention can be damned expensive, as the latest addition to the medical literature demonstrates. The Jupiter study, paid for by the makers of Crestor, the most expensive statin on the market, is pretty darn convincing from a statistical point of view. Dr. Wes and others point out, though, that the impressive risk reductions seen come at rather a significant monetary cost; to whit, $213,000 to prevent one cardiovascular event, by Dr. Wes' (corrected) calculations. Happy the Hospitalist then goes off on a tear about "Should America pay $1,400 a year per person per year to prevent an event that lifestyle changes can do far better, for free?" A straw man argument if ever there were one, because of course other lifestyle changes are free, but presumably what the Jupiter study showed was that Crestor reduced cardiovascular risk even further.

Although "Prevention" does not save money -- in fact, it can be quite expensive -- the question remains "Is it worth it?" Because we live in the United States, each individual gets to make that decision for him or herself. Because guess what, Happy, you aren't paying for anyone's Crestor but your own. Whether or not an insurance company chooses to cover the drug for low-risk patients is also an individual decision. Hell, I'd probably offer my patients cheap generic statins, because so far just about every benefit turns out to be a class effect. $40 a year ($10 for a 90-day supply) for simvastatin at Target? To halve the risk of a cardiovascular event? I bet Happy (and most other active people) pay more than that for shoes in one year.

Just to make it even more convincing, though, I looked at Dr. Wes' numbers and found them a little unrealistic:

• $250 for LFTs? Quest charges me $12; I charge the patient $20.
• $150 for lipids? My charge is $35.
• Knock the statin cost down to $40 a year

Here's how it adds up now:

• Lipid level evaluation ($35 per test x 5 years) = $175
• C-reactive protein level ($20 per year x 5 years) = $100
• Annual liver function tests: ($20 per test per year x 5 years) = $100
• Annual statin costs ($40 per year x 5 years) = $200
• Number of people needing to be treated over 5 years to prevent one cardiovascular event: 25
• TOTAL DOLLARS TO SAVE ONE CARDIOVASCULAR EVENT: $14,375

More than an order of magnitude less, and it actually comes down to less than $100 per person per year. Add in a good pair of running shoes for that exercise regimen, and you're still talking less than $20 per month; way less than what most smokers spend on cigarettes.

Look, I agree wholeheartedly with HH and others that people need to take more responsibility for their health. But you have to admit that the ones eating those McBypass burgers from the drive-through on their way to buy cigarettes to go sit on the couch watching TV are NOT the ones beating down our doors looking for the latest and greatest ways to cut their cardiovascular risk. But for those conscientious patients paying their own bills who are looking to optimize their health, you have to admit this is an exciting study.

Preventive care does not save money. Never did; never will. Just because lots of people make the claim doesn't make it true. Preventive medicine needs to be looked at for its own sake instead of strictly from a financial point of view. The whole concept of risk is an individual one: you may not mind going out in a thunderstorm knowing that the risk of being struck by lightning is remote; your little sister may cower inside in terror. Preventive medicine is, at its heart, the exercise of reducing risk. Just don't go about it thinking you're going to save money.