Public health and prevention in Europe: Is it cost-effective?

  • Simoens S
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OBJECTIVES: In the public debate surrounding public health and prevention, it is sometimes assumed that preventive interventions are by definition cost-effective. This study aims to explore whether preventive pharmaceutical interventions are more cost-effective than a curative approach to diseases. METHODS: A descriptive study identified European economic evaluations in the Tufts Medical Center Cost- Effectiveness Analysis Registry between 2000 and 2007. Data were extracted on publication year, target population, intervention, patient sample, disease, preven- tion stage, and incremental cost-utility ratio of each economic evaluation. Preven- tive interventions were defined as measures preventing disease onset. Curative interventions related to measures identifying patients with risk factors or preclin- ical disease or interventions limiting disability after harm has occurred. Results were expressed in terms of costs (valued in 2008 Euro) per quality-adjusted life year. The association between incremental cost-utility ratios and prevention stage was examined by means of the Mann-Whitney U-test. RESULTS: The analysis included 231 studies that reported information about 608 incremental cost-effec- tiveness ratios. Preventive interventions included interventions that were more effective and less expensive than comparators (41% of incremental cost-effective- ness ratios), and interventions that improved outcomes and increased costs (59%). Both preventive and curative interventions covered the full range of cost-effective- ness results. However, preventive interventions had a significantly lower median ratioof6, 255 perquality-adjustedlifeyearandwerethusmorecost-effectivethan curative interventions (12, 917 per quality-adjusted life year) (p = 0.002). CONCLUSIONS: Although the cost-effectiveness of preventive interventions varies substantially, preventive interventions tended to be more cost-effective than cu- rative interventions.

Author-supplied keywords

  • Cost-effectiveness
  • Pharmaceuticals
  • Prevention
  • Public health

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  • Steven Simoens

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