Preventing fatal diseases increases healthcare costs: cause elimination life table approach

BMJ 1998;316:26-29 (3 January)

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Preventing fatal diseases increases healthcare costs: cause elimination life table approach

Luc Bonneux, medical epidemiologist,^a Jan J Barendregt, mathematical economist,^a Wilma J Nusselder, demographer,^a Paul J Van der Maas, professor of public health ^a

^a Department of Public Health, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands

Correspondence to: Dr Bonneux bonneux@mgz.fgg.eur.n1

Objectives: To examine whether elimination of fatal diseaseswill increase healthcare costs.
Design: Mortality data from vital statistics combined with healthcarespending in a cause elimination life table. Costs were allocatedto specific diseases through the various healthcare registers.
Setting and subjects: The population of the Netherlands, 1988.
Main outcome measures: Healthcare costs of a synthetic lifetable cohort, expressed as life time expected costs.
Results: The life time expected healthcare costs for 1988 inthe Netherlands were £56 600 for men and £80 900for women. Elimination of fatal diseases—such as coronaryheart disease, cancer, or chronic obstructive lung disease—increaseshealth- care costs. Major savings will be achieved only by eliminationof non-fatal disease—such as musculoskeletal diseases andmental disorders.
Conclusion: The aim of prevention is to spare people from avoidablemisery and death not to save money on the healthcare system.In countries with low mortality, elimination of fatal diseasesby successful prevention increases healthcare spending becauseof the medical expenses during added life years.

Key messages

In countries with low mortality prevention of fatal diseases adds life years predominantly to old age, when disabling conditions are prevalent
If fatal diseases are eliminated, the medical costs of life extension at old age will generally be higher than the costs prevented. Prevention of disabling conditions, particularly mental disorders and musculoskeletal conditions, might both lower healthcare costs and improve public health
The aim of prevention is to save people from preventable morbidity and mortality not to save money
For the time being, prevention of disability should have the highest priority for future research

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Relevant Article

Earlier study of effect on healthcare costs of preventing fatal diseases yielded similar results: A S St Leger
BMJ 1998 316: 1985. [Extract] [Full Text]

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