One angle of the health care debate that seems to finally be getting a bit of attention is the dynamic between disease management and prevention. Most of the spending today on health care is geared towards the former — in fact doctors get paid for doing tests and prescribing drugs, they don’t get paid for getting people to lose weight or to quit smoking.
One of the problems with how prevention is measured is the fact its benefit is measured as dollars saved, which rarely enables prevention measures to stack up. They just don’t “save” enough money or it’s just plain impossible to calculate how much money they do save. But there is another way to think about prevention, and that’s in terms of how much benefit one gains by spending on prevention.
Pauline Chen’s piece in today’s NY Times cites a measure called a QALY — Quality Adjusted Life Year — and utilized in numerous studies, including most recently by Dr. Steven Woolf of Virgina Commenwealth University. Woolf uses examples like smoking cessation (e.g. a $5,000 investment in getting someone to quit smoking yields one QALY) and the case that taking a children’s aspirin daily yields QALYs at a third to a fifth the cost of angioplasty.
Another way to look at QALYs is the fact that by one estimate 100,000 lives could be saved a year by investing in 5 key preventitive measures:
1. breast cancer creening in women 40 and older
2. flu immunizations in adults 50 and over
3. colorectal cancer screening in adults 50 and over
4. smoking cessation counseling
5. daily aspirin in high risk cardiovascular patients
Now, it’s just my nature to think about the other side of the QALY equation — you know, the top 5 what I would call “non-preventitive” measures that would surely reduce your QALYs:
1. increased volume of bungee jumping and/or base jumping — particularly with bad ropes or parachutes
2. consumption of soft serve ice cream — especially chocolate dipped cones
3. exceeding the recommended “one glass of wine” a night rule — by like 3–4 glasses a night
4. having any special family nights that sound like “family steak night” or “family pork rind and ranch dip night”
5. convincing yourself that playing World of Warcraft is a form of exercise
All kidding aside, it’s refreshing to see some effort being made in trying to measure what real preventitive health measures might be worth — doing this just might lead to more aspirin consumption and fewer angioplasty procedures.
Originally published on Medium on July 24, 2009. This Substack version is maintained as the canonical archive.