Neumann Peter J, Cohen Joshua T
Tufts University School of Medicine.
Synth Proj Res Synth Rep. 2009 Sep(18). Epub 2009 Sep 1.
It is well established that preventive care reduces the prevalence of disease and helps people live longer, healthier lives. Analysis of the cost-effectiveness of preventive care can guide policy-makers to allocate scarce resources. This synthesis reviews the evidence on the cost-effectiveness of clinical preventive care. Key findings include: although many preventive services are a good value (defined as costing less than $50,000 to $100,000 per Quality Adjusted Life Year), only a few, such as childhood immunizations and counseling adults on the use of low-dose aspirin are widely regarded as cost-saving. Costs to reduce risk factors, screening costs, and the cost of treatment when disease is found can offset any savings from preventive care. Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity. Whether these additional competing risk costs outweigh the savings from avoiding the targeted disease depends on how healthy people are during the added life years. Given that so few preventive services save money and that these services are already in wide use, it is unlikely that prevention can reduce health care spending. The authors question whether the emphasis on savings is appropriate and suggest it is better to focus on high value preventive care, taking into account increased longevity and quality of life.
众所周知，预防性保健可降低疾病患病率，并帮助人们更长寿、更健康地生活。对预防性保健的成本效益进行分析可指导政策制定者分配稀缺资源。本综述回顾了关于临床预防性保健成本效益的证据。主要发现包括：尽管许多预防性服务性价比高（定义为每质量调整生命年成本低于50,000至100,000美元），但只有少数服务，如儿童免疫接种和为成年人提供低剂量阿司匹林使用咨询，被广泛认为具有成本节约效益。降低风险因素的成本、筛查成本以及发现疾病时的治疗成本可能会抵消预防性保健带来的任何节省。预防可降低疾病发病率，但节省的费用可能会被与寿命延长相关的医疗保健成本部分抵消。这些额外的竞争性风险成本是否超过避免目标疾病所节省的费用，取决于人们在延长的生命年限中的健康状况。鉴于很少有预防性服务能省钱且这些服务已广泛使用，预防不太可能降低医疗保健支出。作者质疑强调节省是否合适，并建议最好关注高价值的预防性保健，同时考虑到寿命延长和生活质量的提高。
