Disease Prevention Often Costs More Than It Saves

CHICAGO -- When it comes to health care spending, an ounce of prevention is seldom worth a pound of cure. Take Mrs. Jones, a hypothetical 55-year-old obese woman at risk for diabetes. It costs $900 a year to hire a personal lifestyle coach to help her lose weight and prevent diabetes. Suppose that the coaching works for Mrs. Jones, and she is spared diabetes and all the resulting health bills.

But research shows that for every person like Mrs. Jones, six other people just like her get nothing out of such a program. They either don't lose weight or get diabetes anyway or wouldn't have developed it in the first place. The yearly cost of the prevention program for those six people: $5,400.

That's probably more than Mrs. Jones' health bills from diabetes would have amounted to.

There goes your pound of cure.

The truth is, shockingly few prevention efforts actually save the health care system money overall, despite claims by the president and some in Congress.

Discussing daily aspirin use with people at risk of heart disease does save money. So do vaccinations for children. When doctors talk to smokers and offer medication to help them quit, that, too, saves money.

But those are the exceptions.

Prevention is a good deal, some experts say, if you can buy one year of perfect health for less than $50,000. The most-recommended prevention efforts -- like flu shots for adults, Pap smears for women and colon cancer screening for people over 50 -- meet that cutoff. But they certainly don't save money.

Some say cost is beside the point, since those things save lives at what's deemed a reasonable expense.

Back to Mrs. Jones. Helping 100 people like her would cost $270,000 over three years, but also would prevent 15 new cases of diabetes, avoid the need for blood pressure or cholesterol-lowering pills in 11 people, avoid $65,500 in medical spending for all 100 people and prevent 162 missed days of work due to sickness.

Dr. Ronald Ackermann at Indiana University School of Medicine in Indianapolis said recent studies suggest that offering the diabetes prevention program to groups of 10 people -- instead of one-on-one coaching -- can lead to similar benefits and cost as little as $15 per month.

The YMCA is offering just such a group program. Retired accountant Paul Mullen, 66, of Indianapolis, has lost 18 pounds since May and brought his blood sugar down because of lifestyle changes he learned. He pays $115 for the yearlong program, on top of his Y membership fee.

He feels better, his knees don't hurt as much and he can't wait to see his doctor's reaction when he gets his next checkup.

"I should have done it years ago," he said. "My daughter-in-law got after me. The wife did, too. So far, it's worked."