Michelle Bachmann could be our next president.

[leftysergeant]

If that's the case, then he's falling into the trap. Colon cancer screening increases costs because it has to be administered to a very large number of healthy people in order to detect colon cancer in a relatively small number of people who would get it.

Would you happen to know the total cost for a colonoscopy and removal of a polyp versus the cost of treating one patient for one year with advanced colo-rectal cancer?

 

[Bri]

My point is, it should be a cost-benefit analysis and not simply an analysis of cost.

I don't think anyone disagrees with that. The question is whether politicians are accurate when they say that increasing prevention would cost less money.

-Bri

 

[Bri]

Would you happen to know the total cost for a colonoscopy and removal of a polyp versus the cost of treating one patient for one year with advanced colo-rectal cancer?

Sorry, I was confusing prostate cancer screening with colon cancer screening. I believe that both are addressed in the study and I believe the numbers are listed there. In an earlier post, I quoted an exerpt from an interview with the authors where they talk specifically about prostate cancer screening as an example:

But only 19 percent of the preventive interventions you looked at ended up saving money. Some cost a lot more.
NEUMANN: One example is prostate-cancer screening. It seems to be inefficient.
You have to spend a lot to catch the few cases that threaten people's health.

I don't know if colon cancer screening is among the 19% of procedures that actually save money, but my guess is that due to the large number of people who would have to get colonoscopies compared with the relatively small number of cases of colon cancer caught by those colonoscopies, it would be cheaper not to do the screenings. That doesn't mean the screenings aren't worth the cost, just that they cost more than treating the relatively few cases of colon cancer that would occur without the screenings.

-Bri

 

[JoeTheJuggler]

Immunizations are among the 19% of procedures that were shown to be cost effective according to the study.

But they're not just a little cost effective! Consider diseases eradicated, ripple effects throughout the rest of the economy from epidemics we no longer experience, people requiring lifelong treatment (polio?).

My point is, it should be a cost-benefit analysis and not simply an analysis of cost.

I don't think anyone disagrees with that. The question is whether politicians are accurate when they say that increasing prevention would cost less money.

I think they're probably not considering benefits per cost. So I don't think everyone agrees that it's the best way to investigate whether or not the claim is accurate.

 

[Bri]

But they're not just a little cost effective! Consider diseases eradicated, ripple effects throughout the rest of the economy from epidemics we no longer experience, people requiring lifelong treatment (polio?).

Of course. That's why the vast majority of children are already immunized. There's probably not going to be a huge increase in immunizations due to health care reform though. Immunizations are readily available now and are inexpensive (and I suspect that children can already be immunized for free if their parents can't afford them).

I think they're probably not considering benefits per cost. So I don't think everyone agrees that it's the best way to investigate whether or not the claim is accurate.

The claims in question made by politicians are specifically about monetary savings. That's the problem with the claims. As an example, Obama claimed that his health care plan would actually lower monetary costs due to savings on expensive treatments for diseases that could be detected earlier by providing free preventive procedures. But the preventive procedures offered cost more money than treating the diseases they would prevent. It wouldn't have been a problem if he said that preventive procedures would cost more money but save lives, but instead he said that they would cost less money and save lives.

-Bri

 

[leftysergeant]

Actually, any discussion of the health care reforms are irrelevant to the fact that the little twit Bachmann is trying to sell us the same old tired GOP BS. Her suggestions as to funding VA health care alone show her to be stupid beyond all redemption, on top of being a rotten person and unfit to govern.

The little drongo wants to give the rich a tax cut out of the pockets of disabled veterans at a time when we are generating an endless supply of brain-damaged veterans.

I hope she is mauled by pit bulls.

 

[JoeTheJuggler]

But the preventive procedures offered cost more money than treating the diseases they would prevent.

While that's true of some preventive procedures, it's only true if you also don't calculate the difference in outcomes as part of the cost.

Again, just comparing the dollar costs of preventing a disease and treating a disease after you've gotten it is comparing apples and oranges. There is a tremendous health benefit in prevention. (HIV, for instance?)

 

[JoeTheJuggler]

The claims in question made by politicians are specifically about monetary savings. That's the problem with the claims.

I think you're giving the claims an unfair and overly-restrictive interpretation. I think they're saying that it is more cost-effective. And that is a measure that would have to take into account outcomes.

 

[Bri]

I think you're giving the claims an unfair and overly-restrictive interpretation. I think they're saying that it is more cost-effective. And that is a measure that would have to take into account outcomes.

Well, no. That's the point. When politicians talk about preventive care, they tend to separate outcomes from money, claiming that it both improves outcome AND saves money. Here's an example quote from Obama:

"Insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies — because there’s no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives."​

It may make sense, it definitely saves lives, but the evidence suggests that it doesn't save money.

-Bri

 

[Skeptic Ginger]

I believe you. After all, if PM saves people's lives, those same people will, in the long run, incur more health care expenses than if they'd just died of a preventable condition that might have been caught, for example, by a screening test in a regular check-up (i.e. preventive medicine).

If you prevent chronic disease or decrease the impact of it, your assumptions here fail. If you prevent a head injury with a helmut, you might be preventing the need to care for someone for the rest of their life.

Not every preventative measure is intended to only prevent death.

 

[Skeptic Ginger]

People in the medical field have no stranglehold on reading comprehension.

It isn't reading comprehension that is the problem here. The problem is in understanding the implications and significance.

It is common practice to look at the cost benefit of preventative care when determining for whom and how often a measure should be recommended. So finding a review that summarizes the findings of such analyses is expected to find evidence for and against any number of preventative measures.

The HUGE DISCONNECT HERE is people unfamiliar with that very basic practice don't get it that if there is a preponderance of evidence that a preventative medical intervention is not cost effective, the the medical community will not recommend the measure be implemented. How would we know to make a recommendation or not if the analyses wasn't done?

THAT'S THE WHOLE POINT OF SCIENTIFIC EVIDENCE BASED MEDICINE!!!!! OF COURSE THERE ARE GOING TO BE RESULTS THAT [X] IS NOT WARRANTED.

Sorry, but the ignorance here masquerading as reading comprehension is annoying.

 

[JohnnyG]

It isn't reading comprehension that is the problem here. The problem is in understanding the implications and significance.

It is common practice to look at the cost benefit of preventative care when determining for whom and how often a measure should be recommended. So finding a review that summarizes the findings of such analyses is expected to find evidence for and against any number of preventative measures.

The HUGE DISCONNECT HERE is people unfamiliar with that very basic practice don't get it that if there is a preponderance of evidence that a preventative medical intervention is not cost effective, the the medical community will not recommend the measure be implemented. How would we know to make a recommendation or not if the analyses wasn't done?

THAT'S THE WHOLE POINT OF SCIENTIFIC EVIDENCE BASED MEDICINE!!!!! OF COURSE THERE ARE GOING TO BE RESULTS THAT [X] IS NOT WARRANTED.

Sorry, but the ignorance here masquerading as reading comprehension is annoying.

Once again you are arguing against point I never made. Keep attacking that strawman all you want, it does not change the fact that the comprehension failure is yours.

 

[Skeptic Ginger]

Sorry, I was confusing prostate cancer screening with colon cancer screening. I believe that both are addressed in the study and I believe the numbers are listed there. In an earlier post, I quoted an exerpt from an interview with the authors where they talk specifically about prostate cancer screening as an example:



I don't know if colon cancer screening is among the 19% of procedures that actually save money, but my guess is that due to the large number of people who would have to get colonoscopies compared with the relatively small number of cases of colon cancer caught by those colonoscopies, it would be cheaper not to do the screenings. That doesn't mean the screenings aren't worth the cost, just that they cost more than treating the relatively few cases of colon cancer that would occur without the screenings.

-Bri

OK, let's take your prostate cancer example. Here's the American Cancer Society's recommendation regarding that particular preventative measure:

Prostate cancer
The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment.

Starting at age 50, talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you. If you are African American or have a father or brother who had prostate cancer before age 65, you should have this talk with your doctor starting at age 45. If you decide to be tested, you should have the PSA blood test with or without a rectal exam. How often you are tested will depend on your PSA level. For more information, please see our document, Prostate Cancer: Early Detection.

(emphasis mine)

Colorectal cancer screening provides an example to look at the complexities of assessing the cost effectiveness of any preventative medical intervention. Cost-Effectiveness of Colonoscopy in Screening for Colorectal Cancer

Perspective: Third-party payer.
Conclusions: Colonoscopy represents a cost-effective means of screening for colorectal cancer because it reduces mortality at relatively low incremental costs. Low compliance rates render colonoscopy every 10 years the most cost-effective primary screening strategy for colorectal cancer....

Without screening, the cohort of 50-year-old persons will experience 5904 cases of colorectal cancer and a loss of 10 602 cancer-related lifeyears. Screening with fecal occult blood testing prevents 16% of all colorectal cancers compared with prevention rates of 34% or 75% with flexible sigmoidoscopy or colonoscopy, respectively...

...The results of baseline conditions suggest the following interpretation. Fecal occult blood testing represents a cost-effective option compared with no screening. Flexible sigmoidoscopy is an expensive alternative to fecal occult blood testing. Colonoscopy is associated with relatively modest incremental costeffectiveness compared with fecal occult blood testing and no screening....

Table 3, for each 100 000 persons turning 50 years of age, it would cost (in current discounted dollars) $39 million for fecal occult blood testing, $180 million for flexible sigmoidoscopy, and $190 million for colonoscopy until that cohort dies out. About 4 million persons annually turn 50 years of age. If everyone were screened with fecal occult blood testing, the expected annual screening cost would amount to $1.6 billion ($39 million 3 40). Using colonoscopy, the annual screening costs would be $7.6 billion. Our calculation suggests a substantial increase in the cost investment for colorectal cancer screening. Some of the investment would be saved by spending less money on medical care for cancer (Table 3). These crude estimates do not consider the fact that many persons already undergo some type of screening. Moreover, only a fraction of the population may actually want to participate in a screening program for colorectal cancer.

So, to summarize that, if one only looked at the cost of medical care, fecal occult blood testing saves more money than the cost of treating the cancer it would prevent in the same population. Colonoscopy screening of the whole population is more expensive than the cost of cancer care it would prevent. BUT we also have the cost of years of life and the productivity of that person lost or saved.

So as a medical provider and from society's perspective, screening the population with colonoscopies using the recommended guidelines of age and frequency is cost effective. From the limited perspective of only the medical expenditures, only screening for fecal occult blood is cost effective.


A lot of these analyses are reported as cost per life year saved. The dollar figure is calculated after the cost of treating the disease which would be prevented is subtracted from the cost of screening a whole population. What is reasonable to spend comes down to what we can afford. If your resources are unlimited, then more screening tests make sense. If your resources are limited then only the best bang for your buck is warranted.

This is the same for preventative health interventions which are not related to screening tests. There's no doubt that measures which successfully decrease smoking, seat belt and helmut laws, and smoke alarm campaigns are cost effective. Other measures such as efforts to stop drunk driving depend on their proven effectiveness. We aren't there yet with interventions for health costs related to alcohol use or obesity. That doesn't mean we should stop looking for such interventions.

 

[JoeTheJuggler]

If you prevent chronic disease or decrease the impact of it, your assumptions here fail. If you prevent a head injury with a helmut, you might be preventing the need to care for someone for the rest of their life.

Not every preventative measure is intended to only prevent death.

I was being snarky--similar to the way I agree with right-wingers that the New Deal prolonged the Depression by preventing people from starving to death in great numbers.

 

[Skeptic Ginger]

Once again you are arguing against point I never made. Keep attacking that strawman all you want, it does not change the fact that the comprehension failure is yours.

You are not the only person I am responding to here.

But speaking of straw men:

The blanket statement that "PM saves money" is not supported by evidence.

No one said it was.

Let's go back to the start here:

nonsense.

What about this study in the New England Journal of Medicine...

Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.

To which I said, "That's a misleading cherry pick you quoted."

"Vast majority of preventative measures don't save money" falsely represents what that paper says.

So what straw man are you referring to?

 

[Skeptic Ginger]

I was being snarky--similar to the way I agree with right-wingers that the New Deal prolonged the Depression by preventing people from starving to death in great numbers.

I'm not the best at interpreting snark. Sorry.

 

[JoeTheJuggler]

Well, no. That's the point. When politicians talk about preventive care, they tend to separate outcomes from money, claiming that it both improves outcome AND saves money. Here's an example quote from Obama:

"Insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies — because there’s no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives."​

It may make sense, it definitely saves lives, but the evidence suggests that it doesn't save money.

First, here again is an example that the politician in question was indeed speaking of both cost and outcomes.

But even to the narrow interpretation of the claim, I think you're wrong that evidence suggests that what Obama said "routine checkups and preventive care, like mammograms and colonscopies" doesn't indeed save money.

Here, I'll side with Skeptic Ginger:

It is common practice to look at the cost benefit of preventative care when determining for whom and how often a measure should be recommended. So finding a review that summarizes the findings of such analyses is expected to find evidence for and against any number of preventative measures.

If Obama isn't insisting on things like PSA screenings for prostate cancer, then I'd say he's right. And I don't think he was. Contrary to some of the criticism, I don't think he's trying to second guess medical opinion. He's trying to take these decisions away from the insurance companies and give them to the doctors and patients.

This is why I say you're putting an unfair spin on the claim. If you asked Obama if he includes in "preventive care, like mammograms and colonoscopies" cost-ineffective tests, do you think he'd say yes? He certainly didn't say he wants mandatory coverage for any and all preventive care measures anyone thinks up.

 

[JoeTheJuggler]

I'm not the best at interpreting snark. Sorry.

Meh--it was a pretty feeble effort on my part. (Bri had to ask if I was being serious too, so it obviously wasn't very good.)

 

[Bri]

Colonoscopy screening of the whole population is more expensive than the cost of cancer care it would prevent. BUT we also have the cost of years of life and the productivity of that person lost or saved.

So as a medical provider and from society's perspective, screening the population with colonoscopies using the recommended guidelines of age and frequency is cost effective. From the limited perspective of only the medical expenditures, only screening for fecal occult blood is cost effective.

Exactly what I'm saying.

Let's say there are two health care plans under consideration. Plan "A" provides free prostate screening to everyone. Plan "B" provides no prostate screening, but does cover treatment for people who get prostate cancer.

If a politician who endorses Plan "A" claims that it costs less money than Plan "B" they would be incorrect. Plan "B" costs less.

Certainly it can be argued that Plan "A" is better because it prevents more cancer, and is therefore "cost effective" in terms of lives saved. But Plan "A" doesn't save money over Plan "B".

-Bri

 

[Bri]

First, here again is an example that the politician in question was indeed speaking of both cost and outcomes.

He said that we would both save more lives AND we'd spend less money doing so. This is false. We might save more lives by increased preventive care, but we would spend more money doing so.

This is why I say you're putting an unfair spin on the claim. If you asked Obama if he includes in "preventive care, like mammograms and colonoscopies" cost-ineffective tests, do you think he'd say yes? He certainly didn't say he wants mandatory coverage for any and all preventive care measures anyone thinks up.

Please don't conflate "cost-effective" with "saves money." The former simply means that the return (in terms of saved lives, etc) is worth the extra cost. Obama said that the additional preventive care would save money. But over 80% of preventive procedures don't, in fact, save money. If Obama had limited himself only to those 19% or so preventive procedures that actually do save money, his statement would be accurate. But he didn't.

ETA: Obama actually mentions mammograms and colonoscopies specifically. Mammograms don't save money according to most sources. Colonoscopies only save money if done once between ages 60 and 65 (if done any more than that they cost more money than they save in treatment for colon cancer). Again, that is not to say that the extra costs of mammograms and extra colonoscopies aren't worth it -- just that they don't save money.

-Bri