Making the economic case for prevention--a view from Wales.
BACKGROUND
It is widely acknowledged that adverse lifestyle behaviours in the population now will place an unsustainable burden on health service resources in the future. It has been estimated that the combined cost to the NHS in Wales of overweight and obesity, alcohol and tobacco is in excess of £540 million.In the current climate of financial austerity, there can be a tendency for the case for prevention efforts to be judged on the basis of their scope for cost savings. This paper was prompted by discussion in Wales about the evidence for the cost savings from prevention and early intervention and a resulting concern that these programmes were thus being evaluated in policy terms using an incorrect metric. Following a review of the literature, this paper contributes to the discussion of the potential role that economics can play in informing decisions in this area.


CONCLUSIONS
This paper argues that whilst studies of the economic burden of diseases provide information about the magnitude of the problem faced, they should not be used as a means of priority setting. Similarly, studies discussing the likelihood of savings as a result of prevention programmes may be distorting the arguments for public health.Prevention spend needs to be considered purposefully, resulting in a strategic commitment to spending. The role of economics in this process is to provide evidence demonstrating that information and support can be provided cost effectively to individuals to change their lifestyles thus avoiding lifestyle related morbidity and mortality. There is growing evidence that prevention programmes represent value for money using the currently accepted techniques and decision making metrics such as those advocated by NICE.


CONCLUSIONS
The issue here is not one of arguing that the economic evaluation of prevention and early intervention should be treated differently, although in some instances that may be appropriate, rather it is about making the case for these interventions to be treated and evaluated to the same standard. The difficulty arises when a higher standard of cost saving may be expected from prevention and public health programmes.The paper concludes that it is of vital importance that during times of budget constraints, as currently faced, the public health budgets are not eroded to fund secondary care budget shortfalls, which are more easily identifiable. To do so would diminish any possibility of reducing the future burden faced by the NHS of lifestyle-related illnesses.
Health, Social Services and Children Analytical Team, Welsh Government, 4th Floor, North Core, Cathays Park, Cardiff CF10 3NQ, UK. Janine.Hale@wales.gsi.gov.uk
Janine
J
Hale
Ceri J
CJ
Phillips
Tony
T
Jewell
D000329:Advertising / Q000191:economics; D000428:Alcohol Drinking / Q000453:epidemiology; D017046:Cost Savings; D017281:Cost of Illness; D005102:Health Expenditures / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D008019:Life Style; D009313:National Health Programs / Q000331:legislation & jurisprudence; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D011314:Preventive Health Services / Q000191:economics*; D011634:Public Health / Q000191:economics / Q000379:methods; D012907:Smoking / Q000453:epidemiology; D013222:State Medicine / Q000191:economics*; D014852:Wales / Q000453:epidemiology