Dutch study on lifetime medical costs merits close reading
Category: Medicine... Society & Culture...
Posted Tuesday, February 05, 2008 at 07:46 PM [GMT-6]

A Dutch study is getting a lot of press over its findings that healthy people actually incur higher total medical expenses than those who are obese or who smoke, because the latter tend to die earlier. However, the conclusions of the study are not as straightforward as some news media reports are implying.

The study, entitled Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure, does indeed show (statistically, anyway; the study was based on a simulation model, not actual people) that the typical smoker or obese person will incur lower medical costs over the course of their lives than those who lead more healthy lifestyles. And, not surprisingly, a longer lifespan is accompanied by higher total medical costs than a shorter one.

But it's important to understand that the researchers are not suggesting that programs to eliminate smoking or reduce obesity should be eliminated, de-funded, or even de-emphasized, because there's more to the issue than the arithmetic of medical expense. From the study:

...it is important to stress that we have focused solely on health-care costs related to smoking and obesity, ignoring broader cost categories and consequences of these risk factors to society. It is likely, however, that these impacts will be substantial. For instance, reduced morbidity in people of working age may improve productivity and thus result in sizable productivity gains in society. In the case of smoking and obesity, these indirect costs could well be higher than the direct medical costs. Moreover, from a societal perspective, other potentially substantial costs and consequences need to be considered, such as those related to informal care, the damage due to fires caused by smoking, or the reduced well-being of family members due to morbidity and premature death.

So, while some may attempt to use this study as justification for reduced emphasis on these health issues, they'll do so in direct disregard of one of the most important conclusions by the researchers:

If prevention can bring additional health to a population at relatively low costs, it is a good candidate for funding. However, the present study demonstrates that sound estimates of medical costs in life-years gained should be taken into account in cost-effectiveness analysis of prevention. In this respect it is interesting to note that in the area of smoking cessation and weight loss, favorable cost-effectiveness results have been shown even if medical costs in life-years gained are taken into account. Prevention may therefore not be a cure for increasing expenditures—instead it may well be a cost-effective cure for much morbidity and mortality and, importantly, contribute to the health of nations.

In other words, the focus should not be exclusively or even primarily on those lifetime medical expenditures.

If nothing else, this highlights the importance of going straight to the source rather than relying on an AP newswire summary.

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Comments

Having spent $90,000+ to get my heart fixed a few years ago....and being of sound body today, I vote for spending more and living longer.

Posted by: Wallace at February 6, 2008 03:39 PM

I noticed you were quite specific about which part of you is sound. ;-)

Posted by: Eric at February 6, 2008 04:58 PM

I have seen the toll on family which resulted from the premature death of a morbidly obese member. This toll was both psychological and financial.

Posted by: jim at February 13, 2008 06:16 PM
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