Title: Prevention May be Costlier than a Cure
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Permanent Link: http://ufdc.ufl.edu/WL00001454/00001
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Title: Prevention May be Costlier than a Cure
Physical Description: Book
Language: English
Publisher: Wall Street Journal
 Subjects
Spatial Coverage: North America -- United States of America -- Florida
 Notes
Abstract: Prevention May be Costlier than a Cure, July 6, 1994
General Note: Box 8, Folder 5 ( Vail Conference, 1995 - 1995 ), Item 68
Funding: Digitized by the Legal Technology Institute in the Levin College of Law at the University of Florida.
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Bibliographic ID: WL00001454
Volume ID: VID00001
Source Institution: Levin College of Law, University of Florida
Holding Location: Levin College of Law, University of Florida
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I HEALTH


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Prevention May Be Costlier Than a Cure


By DAVID STIPP
Staff Reporter of THE WALL STREET JOURNAL
Which saves lives more cheaply, heart
transplants or curbing industrial pollution
to prevent cancer?
If you picked ounces of cancer preven-
tion over pounds of heart cure, ponder this:
Each year of life bought by a heart
transplant costs, on average, $104,000. But
a life-year saved by preventing factories
from releasing carcinogenic substances
like formaldehyde and benzene generally
costs more than $2.5 million.
That's what a sweeping study of cost-
benefit estimates by the Harvard School of
Public Health's Center for Risk Analysis
shows. The ongoing "lifesaving" study is
the broadest comparison to date of the
estimated bang for bucks from ways to
avert premature deaths.
Findings so far suggest that:
Medical care generally saves lives at
less cost than workplace-safety or environ-
mental measures.
Extravagantly large sums are spent to
alleviate minor cancer risks.
Oregon's ranking of Medicaid serv-
ices touted as a possible national model
for setting medical priorities falls far
short of maximizing cost-effectiveness.
Some 60,000 deaths could be averted


Median cost of a year of life saved
by various interventions
cosT
Childhood immunizations Less than zero
Prenatal care Less than zero
Fla shols $600
Water hlorination $4,000
Paneaonia vacloatieo $12,000
Breast cancer sreenino $17,000
Constrilon safety rules $38,000
Home radoon olrol $141,000
Asbestos cotrols $1.9 million
Radiatino crods $27.4 million
Source: arvard tissavht Stady
annually in the U.S. if the $21.3 billion
spent on 185 major life-preserving pro-
grams were reallocated so more went to
the most beneficial measures and less to
the others. Cost-effective spending could
cut about $31 billion in health-care and
other costs without increasing the death
rate.


Critics often blast risk-analysis studies
as biased guesswork dolled up by spin-con-
trol experts to look like hard data. But
outside researchers say the Harvard
study, begun in 1990, appears quite rigor-
ous. Some 90o% of its data were drawn from
government studies or peer-reviewed ones
in technical journals. "Nothing comes
close to Ithe study in breadth and the
number of interventions analyzed," says
Paul Slovic, a risk expert at Decision
Research, a Eugene, Ore., think tank.
Other studies have analyzed cost-bene-
fit ratios for a few dozen measures. The
Harvard team used hundreds of studies to
estimate such ratios for 587 interven-
tions from requiring airbags in cars to
prescribing cholesterol-lowering drugs.
The team calculated the costs per life-
year saved in three main categories: medi-
cine, injury prevention and pollution con-
trol. Costs varied widely. But the study
showed medical interventions generally
thwart the Grim Reaper for less than
injury-prevention measures, such as con-
struction-safety rules or highway improve-
ment, which save lives only when rela-
tively rare accidents occur. And prevent-
ing injuries generally yields more bang
Please Turn to Page B7, Column I


The Price of Prevention Outpaces

The Cost of a Cure, Study Finds


Continued From Page BI
than stringent toxic-release standards.
"It's fashionable to criticize the extra-
vagance of American medicine," says
study author John Graham. But "our
analysis shows a lot of what is done in
medicine is quite effective and reasonable
in cost compared to other ways we invest
money."
Childhood immunizations, drug- and
alcohol-treatment programs and prenatal
care are among the biggest life-saving
bargains, the study shows. These lower the
costs of caring for sick people; thus, total
costs can be more than offset by health-
care savings, bringing per-life-year costs
to less than zero.
Medical treatments sometimes cost
surprisingly little in the study's analysis
because they are used on a small target
group sick people. For example, kidney
dialysis typically saves a life-year for
about $46,000. But broad-brush prevention.
such as installing seat belts in all school
buses ($2.8 million per life-year), generally
pays off for only a small fraction of the
S population.
But the Harvard study doesn't factor in
the myriad considerations that might
make spending effective or ineffective. For
example, a school district where children
died in a bus without seat belts might pay
huge legal settlements, as well as incur
adverse publicity that might cost the


schools voter support for tax levies.
Still, the study shows many prevention
programs are like gold-plated cannons
aimed at flies. The estimated "excess
mortality" they avert, especially in pollu-
tion control, often is minuscule. Consider
the study's most expensive intervention:
preventing releases of carcinogenic chloro-
form at pulp mills, which costs an esti-
mated $99.4 billion for each life-year saved.
I *


demands on institutions to deal with it."
Indeed, the median cost for a life-year
saved by programs to avert cancer deaths
is about S750.000. the study found. The
comparable cost for heart disease is $14.-
000. The heart programs include cho-
lesterol screening for boys at age 10, which
saves a life-year for an estimated $6.500.
Dr. Tengs notes that selective antican-
cer prevention can be cost-effective. A
life-year saved by screening women over
20 annually for cervical cancer costs $224.-
000, compared with S11.000 for annually
screening women over 60.
The Harvard study highlights low- or
no-cost ways to avert death that haven't
politics can skew cost-effectiveness. To
extend health-care coverage, the state
ranked Medicaid services to reflect com-
parative benefits: only services above a
certain ranking are covered.
But between 1990 and 1993. the state put
decreasing weight on cost-effectiveness,
as compared with the Harvard study. "We
found a list based on cost-effectiveness


The chloroform controls at 48 mills studied
cost only $30.3 million annually, says
Tammy Tengs, lead author of the study.
But researchers estimate it would be nec-
essary to spend that much on controls for
more than 33,000 years to avert a single
fatal case of cancer. Dividing the annual
cost by the tiny mortality risk yields the
huge cost-benefit ratio.
"There's a degree of public anxiety
about cancer that's probably dispropor-
tionate to other causes of death," says
Harvard's Dr. Graham. "Cancer is pri-
marily a disease of old age, and we don't
have a very effective battery of strategies
to prevent it. But society places great


been widely implemented or enforced.!
including screening people over 40 for'
colon cancer and mandating that motorcy-
cle drivers keep their lights on.
But "people don't want to live by cost-
effectiveness numbers alone." says Ore-
gon's Mr. Slovic. "People get direct benefit
from cars, so they're willing to tolerate
more risk [from auto accidents than from
cancer caused by strange chemicals used
by industry." Moreover. many favor high-
cost pollution controls because "pollution
is seen as a symbol that the earth is fragile
and that we're destroying it."
The Harvard team's analysis of Ore-
gon's Medicaid rankings underscores how
alone didn't follow the general intuition of
where things should be." says Darren
Coffman. research manager of the Oregon
Health Services Commission. After public
hearings, the commission adjusted the
rankings of about 400 of the 696 items on
the final priority list. he says. .2 .8


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