NCPA - National Center for Policy Analysis

Some Preventive Measures Are Cost-Effective, But Underused

June 29, 2001

If preventive medical services are ranked based on how many lives they save and how much they cost, childhood vaccinations and anti-smoking counseling for adults are the most effective preventive medicine, says a new study.

The study in the July issue of the American Journal of Preventive Medicine examined 30 examples of preventive medicine, giving each a 1-to-5 rating in two categories -- cost- effectiveness and the burden of disease prevented by each service.

Cost-effectiveness was measured as the cost of a preventive service divided by its clinical, or medical, effectiveness. The disease burden was measured by calculating the deaths or injuries that could be delayed or avoided if the preventive service reached its entire target population.

Some of the best preventive measures are reaching surprisingly few Americans.

  • Vaccinating children for diseases like polio and hepatitis was the only measure with a perfect 10.
  • Anti-smoking counseling for adults and eye exams for the elderly were close behind, ranked extremely effective, with combined scores of 9 each.
  • However, the next most effective measures -- getting anti-smoking and anti-drug messages to youngsters -- were found to reach less than half of their target audience.

Two measures were given the lowest possible scores for both disease prevention and cost-effectiveness -- rubella screening for women of childbearing age and tetanus shots for the whole population.

Cholesterol screening, counseling on a balanced diet and regular mammograms for women age 50 to 69 ranked in the middle.

In a commentary published in the journal, a physician with the Kaiser Foundation Health Plan warned that doctors make decisions based on how specific methods help specific patients, not how they compare to other preventive methods.

Source: Ashley B. Coffield, "Priorities Among Recommended Clinical Preventive Services," American Journal of Preventive Medicine, July 2001, and Erin Mcclam, "Study Ranks Preventive Measures," Associated Press, June 22, 2001.


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