The effect of different public health interventions on longevity, morbidity, and years of healthy life.
BACKGROUND
Choosing cost-effective strategies for improving the health of the public is difficult because the relative effects of different types of interventions are not well understood. The benefits of one-shot interventions may be different from the benefits of interventions that permanently change the probability of getting sick, recovering, or dying. Here, we compare the benefits of such types of public health interventions.


METHODS
We used multi-state life table methods to estimate the impact of five types of interventions on mortality, morbidity (years of life in fair or poor health), and years of healthy life (years in excellent, very good, or good health).


RESULTS
A one-shot intervention that makes all the sick persons healthy at baseline would increase life expectancy by 3 months and increase years of healthy life by 6 months, in a cohort beginning at age 65. An equivalent amount of improvement can be obtained from an intervention that either decreases the probability of getting sick each year by 12%, increases the probability of a sick person recovering by 16%, decreases the probability that a sick person dies by 15%, or decreases the probability that a healthy person dies by 14%. Interventions aimed at keeping persons healthy increased longevity and years of healthy life, while decreasing morbidity and medical expenditures. Interventions focused on preventing mortality had a greater effect on longevity, but had higher future morbidity and medical expenditures. Results differed for older and younger cohorts and depended on the value to society of an additional year of sick life.


CONCLUSIONS
Interventions that promote health and prevent disease performed well, but other types of intervention were sometimes better. The value to society of interventions that increase longevity but also increase morbidity needs further research. More comprehensive screening and treatment of new Medicare enrollees might improve their health and longevity without increasing future medical expenditures.
Diehr
Paula
P
Departments of Biostatistics, University of Washington, Seattle, WA, USA. pdiehr@u.washington.edu
Derleth
Ann
A
Cai
Liming
L
Newman
Anne B
AB
D000206:Actuarial Analysis; D003362:Cost-Benefit Analysis; D019468:Disease Management; D006292:Health Priorities / Q000191:economics; D006293:Health Promotion / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006296:Health Services / Q000600:supply & distribution*; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D006278:Medicare; D008954:Models, Biological; D009017:Morbidity; D014481:United States; D014492:United States Public Health Service