The costs of prevention, and the coming boom in comparative effectiveness research

Today's Boston Globe revisits the question of whether screening (vs. other forms of prevention) is a cost-effective approach to improving health care.  Obama has called for more screenings; the CBO and folks like Peter Neumann, Director of the Tufts Center for for the Evaluation of Value and Risk in Health, continue to point out that increased screenings alone will increase, not decrease, health care expenditures in the long run, thus running against the President's budget-neutrality mantra. 

But prevention is about more than screenings.  See my recent post regarding the value of prevention, citing Ken Thorpe (also quoted in today's Globe article).  Prevention would not be at the core of employee health programs at companies like IBM if it didn't save some serious money. Best estimates peg the ROI at about 400%. 

Neumann and Thorpe are both right; they're just answering different questions.  A key issue for the future will be defining effectiveness for purposes of comparative effectiveness research.  Key issues in that exercise include valuation of human life (never an easy task).  See my post on the QALY issue following up another article in which Neumann was quoted, over two years ago.

Finally, tort reform is a red herring: The cost of medical errors is about three to five times the cost of all malpractice insurance premiums, so where's the malpractice crisis (other than in MSM headlines)?

Update August 19, 2009:  See more discussion on tort reform in the comments, and see also The Washington Independent's roundup of reasons why tort reform is unlikely to cut health care costs. 

The challenge with screenings is to mandate or cover only those which are highly predictive, have few false positives (which lead to additional testing for someone who turns out to be healthy), and screen for disease we can treat effectively.  Oh, there it is again, the "e" word.  Let's hope the comparative effectiveness research structure is adequately funded in whatever health reform legislation gets enacted (well beyond the pittance allotted in ARRA), so that this can be addressed in a meaningful way.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting