A review of the economic evidence on prevention.

This study examines the economic evidence on preventive health care. A discussion of benefit-cost analysis and cost-effectiveness analysis, their applications to preventive strategies, and the problems inherent in implementing these approaches precedes a review of the empirical evidence. Prevention strategies are grouped into three categories: lifestyle changes, public health measures and screening programs. Lifestyle changes include altering behavior patterns as they relate to alcohol and drug abuse, smoking and automobile safety regulations. Included in public health measures are immunizations against communicable diseases, water fluoridation and food inspection. Screening includes programs for the detection of PKU and congenital hypothyroidism in newborn infants, for spina bifida cystica in the unborn fetus, and hypertension. The paper concludes that many of the preventive health measures examined represent an efficient use of resources. Because only quantifiable changes in health status or costs are included in the benefit-cost and cost-effectiveness analyses, the actual value of prevention strategies may be understated since reductions in pain and suffering usually are omitted.