Re: Estimating the Cardiovascular Disease Risk Reduction of a Quality Improvement Initiative in Primary Care: Findings from EvidenceNOW

To the Editor: The recent article by Lindner et al concluded, “This [cardiovascular disease] risk reduction would … avoid $150 million in 90-day direct costs.”¹ It was grossly irresponsible of the authors to write this and for the editors to publish this.

This medical economic calculation did not apply the methodologies for cost-effectiveness evaluation and reporting that have been followed for over 25 years.² But we do not even need to understand the intricacies of these extensive guidelines to see the problem. The authors’ “spin” on this issue is identifiable through common sense: they included no upfront costs in their calculation.

They made no effort to include the intervention costs to achieve the preventive outcomes: no clinic visits, medications, lab tests, nothing. My back-of-the-envelope calculation using modest assumptions on cost and utilization (see Table 1) shows that, at a minimum, $3.73 billion must be spent to achieve the $150 million “savings.”

Sloppily reported conclusions like this reinforce the fiction that preventive services save total health care costs. Our national academy, the American Academy of Family Physicians, reinforced this fiction recently when it submitted with the American Medical Association an amici curiae brief to the US Supreme Court that said, “… preventive care … saves money.”³

For the US to achieve a lower-cost, more equitable health care system, Americans must accept the realities of costs and outcomes that every health care system in every other developed country understands. Most often, an ounce of prevention costs a ton of money. Giving a platform to false statements with the imprimatur of scientific truth only digs our country further into a financial hole and delays even further the development of a sustainable national solution to our exorbitant health care costs.