Disease prevention: Saving lives or reducing health care expenditures?

Background: Disease prevention has been claimed to reduce health care expenditures. However, preventing fatal diseases increases life expectancy and, thereby, indirectly increases the demand for health care. Previous studies have argued that on balance preventing fatal diseases increases health care expenditures. However, improved treatment of fatal diseases has both increased survival and health care expenditures. The objective of this research is to investigate if disease prevention could result in both increased longevity and lower lifetime health care expenditures using more recent data and incorporating insights from empirical research arguing that health care expenditures are centred in the last year of life.Methods: Mortality rates in the Netherlands for the year 2009 were used to construct cause-deleted life tables. Data originating from the Dutch Costs of Illness study distinguishing age and gender disease specific costs accounting for high expenditures in the last year of life was incorporated into the life tables in order to estimate lifetime health care expenditures.Results: Elimination of highly fatal diseases would result in increases in life expectancy (LE) and simultaneously increase lifetime health care expenditure. Exemplary are neoplasms with LE +5.2 and +4.4 percent and expenditures +6.5 and +5.2 percent, for men and women respectively. Savings would be incurred when non-fatal diseases are eliminated, for example mental and behavioural disorders (LE +0.3 and +0.6 and expenditures -14.7 and -17.8 percent, for men and women respectively). Diseases of the circulatory system stand out with LE +3.9 and +3.5 percent, for men and women respectively, and expenditures -5.1 percent for men and +0.6 percent for women. This is strongly driven by cardiovascular disease, the only disease group next to neoplasms that for men results in higher lifetime health care expenditure if eliminated.Conclusion: The stronger the negative impact of a disease on longevity, the higher health care expenditure would be after elimination of the disease. Due to successful treatment of CVD, prevention of CVD nowadays would not result in major gains in LE but could cut health care expenditures. This results in a new paradox: successful treatment of fatal diseases leaves less room for life expectancy gains due to prevention but more room for health care savings

Netspar, Network for Studies on Pensions, Aging and Retirement, is a thinktank and knowledge network. Netspar is dedicated to promoting a wider understanding of the economic and social implications of pensions, aging and retirement in the Netherlands and Europe.

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