Medical Device Daily Washington Editor

WASHINGTON — With the current raft of legislation making the rounds on Capitol Hill, the healthcare cost question bedevils policymakers all the more, with the savings said to be associated with those bills serving as a frequent flashpoint in the debate. Expanding the cost-benefit argument to the impact of preventive care on gross domestic product, the Advanced Medical Technology Association (AdvaMed; Washington), held a press conference here yesterday to address the impact of chronic disease on the economy and how preventive care could blunt that impact.

According to the report discussed during the session, the savings to the economy from improved preventive care could hit $1.4 trillion for a set of 13 diseases, but the attainment of these savings would require a substantial boost in federal spending, a spending boost that the study's authors did not attempt to calculate. The study's principal authors also acknowledged a margin of error in the savings calculations of as much as 20%.

Steve Ubl, president/CEO of AdvaMed, noted that his group commissioned the report and said the association's members have "long believed that the true cost driver [of healthcare] is the burden of disease" on the U.S. economy rather than the cost of care. He said that a reduction of indirect costs, such as lost productivity, would turn the tables on the cost question. "If workers are healthier and the burden of disease is reduced," the economy will benefit in a way that meaningfully offsets the cost of care, he said.

"There's a tremendous health dividend if we can prevent disease and improve the quality of care," Ubl said, adding that the Congressional Budget Office's analyses of legislative proposals typically assume that GDP is fixed, which he indicated led to an overstatement of the cost of healthcare reform relative to the size of the U.S. economy.

Leading off the discussion of the study, Bryan Luce, PhD, of the Center for Health Economics and Science Policy (CHESP; Bethesda, Maryland), said the phrase 'indirect cost' "is really a misnomer," asserting that the productivity effects of chronic diseases are very direct costs to the economy.

"Its obvious that disease and productivity are intrinsically linked," Luce argued, even as he acknowledged that "measuring changes in productivity" in a way that captures several tough-to-calculate factors such as presenteeism, "is extremely difficult" and "needs to be done much better." Presenteeism is the blunted productivity experienced by those who are ill, but who nonetheless go to work.

"The evidence is imprecise," Luce said, but countered by asserting, "the precise numbers are not important, it's the general magnitude" of these effects that is important.

Co-author Greg de Lissovoy, PhD, also of CHESP, said the research team combed through more than 1,000 articles to arrive at the 31 studies that described the 13 conditions – both chronic and acute diseases – that formed the basis of the study. "We don't look at conditions such as heart failure," which affects primarily older adults, he said, because the productivity question is irrelevant to many of those over the age of 65.

"We estimate that the 13 conditions we looked at could account for $1.4 trillion, a substantial portion of the $2.4 trillion" the U.S. is said to currently spend on healthcare, Lissovoy said.

"We were very surprised at the impact of substance abuse," Lissovoy remarked, stating that this class of disorders is blamed for draining $255 billion of production from the economy each year. The indirect costs of cancers came in higher than any other of the conditions, at $306 billion.

Sticking with the theme of details-don't-matter, Lissovoy repeated, "it's not the exact numbers that count," it's the general lay of the terrain. In an effort to corroborate the study's conclusions, he cited a report by the Milken Institute (Santa Monica, California), which Lissovoy said concluded that "there could be as much as $1 trillion" added to the economy each year with the appropriate preventive care and behavioral modification.

David Cutler, MD, of Harvard University (Cambridge, Massachusetts), addressed several areas under discussion, but also took square aim at those who oppose healthcare reform.

"You hear from some people that healthcare reform will kill innovation. That's garbage. It will create the biggest market for healthcare that has ever existed," Cutler asserted.

"The need for more innovation in some areas," is one of the things suggested by the study, Cutler said, adding that "we don't know a whole lot about the onset" of some mental health/substance abuse issues. On the other hand, he noted, "we can treat hypertension for about 10 cents a day," but such care is not routinely provided.

Medical Device Daily asked what the statistical margin of error was for the calculation of savings of $1.4 trillion. Lissovoy said, "our margin of error is on the order of 20%," describing the numbers as a "a guesstimate due to methodology questions."

"We have problems in consistency of measurement, but I think we're conservative" in terms of the magnitude of the anticipated effects, Lissovoy said, which he stated did not include a calculation of impact of these 13 diseases on the families of patients.

Among the proposals offered by the study's authors was a federal effort to aid in the fight against preventable diseases described by Lissovoy and Luce as a "man-on-the-moon" project. As for how much such a "moonshot" might cost, Lissovoy said that the Centers for Disease Control and Prevention (Atlanta) "has proposed a program to increase prevention efforts and their budget for this is $5 billion a year." However, he acknowledged that he has no solid basis for measuring how much an exhaustive federal program such as the one he and Luce proposed might cost.

Mark McCarty, 703-268-5690;