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06/26/13

Preventive Medicine Blog Series - Part III: Preventive Procedures

by Emily Podmore, June 26, 2013

Preventive medicine is often broken down into two categories (1) physician office visits and (2) surgical, radiological, and laboratory procedures. The former has become more commonplace, but the latter is still being "felt out" by the medical community and public alike.

Another term for preventive, more commonly used when referring to medical procedures, is prophylactic. Some of the more well-known prophylactic surgeries are mastectomies for women who are predisposed with a gene that makes them more likely to get breast cancer, and dental procedures like removal of the wisdom teeth to prevent future infections and compounding. Prophylaxis, however, can refer to any preventive treatment including vaccines and teeth cleanings.

Preventive treatments like the prophylactic mastectomy for breast cancer are sometimes criticized of being too preemptive, but few women regret their decision to undergo the surgery. Additionally, neither the genetic testing nor the surgery itself is widely available to people of all socio-economic statuses, bringing up another issue. Not to mention, breast cancer survival rates are promising if caught early on (93% if caught before stage 1) and a preventive mastectomy does not completely eliminate the risk of cancer. Yet, most women who undergo the procedure say they would recommend it to someone else in their position. It's a hot topic, and in recent years the number of women undergoing the procedure has jumped by 50%. It's difficult to place a value on these kinds of procedures-they may be expensive and end up outweighing the avoided future costs, but there's much more to it than that.

The Partnership for Prevention commissioned a paper asserting that "effective preventive interventions are those in which the gains for the minority who do benefit are sizable enough to offset the costs and harms of involving the whole population." This is certainly the case for widespread measures, but what about preventive procedures like preventive wisdom teeth extraction or a prophylactic mastectomy?

An economist would define value as the ratio between the cost of a service and its benefits. Something has a higher value if the benefits it reaps are greater than the cost incurred. Determining the value or cost-effectiveness (CE), for preventive procedures can be complicated. Often, these procedures create a sticker shock effect because economic analyses focus on short term returns rather than long term payoffs. Another difficulty is deciding whether to compare the CE to doing nothing or to consider the CE as a marginal value in comparison to treating a disease or illness when it arises.

The economic value of prevention procedures can be limited, and it is crucial to remember that procedures that prevent people from getting an illness or disease hold a human value that cannot be accounted for by numbers and econometrics. And so, perhaps we should not look at these procedures and try to figure out if the added years of life from a procedure will have an economic benefit that offsets the cost of the procedure itself. Maybe it is more important to humanize these preventive procedures and see their results in terms of intrinsic rather than extrinsic value. It is for this reason that preventive procedures are becoming more commonplace-whether they actually represent a more cost-effective model is still under scrutiny. For people, however, preventive interventions just make sense.

(For additional trends in Preventive Medicine see: Here)

Sources
http://www.prevent.org/data/files/initiatives/economicargumentfordiseaseprevention.pdf
http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-survival-rates
http://www.nbcnews.com/health/more-women-opting-preventive-mastectomy-should-they-be-1C9918752