title: Disease prevention: saving lives or reducing health care costs?
abstract: BACKGROUND
  Disease prevention has been claimed to reduce health care costs. However, preventing lethal diseases increases life expectancy and, thereby, indirectly increases the demand for health care. Previous studies have argued that on balance preventing diseases that reduce longevity increases health care costs while preventing non-fatal diseases could lead to health care savings. The objective of this research is to investigate if disease prevention could result in both increased longevity and lower lifetime health care costs.
  
  
  METHODS
  Mortality rates for Netherlands in 2009 were used to construct cause-deleted life tables. Data originating from the Dutch Costs of Illness study was incorporated in order to estimate lifetime health care costs in the absence of selected disease categories. We took into account that for most diseases health care expenditures are concentrated in the last year of life.
  
  
  RESULTS
  Elimination of diseases that reduce life expectancy considerably increase lifetime health care costs. Exemplary are neoplasms that, when eliminated would increase both life expectancy and lifetime health care spending with roughly 5% for men and women. Costs savings are incurred when prevention has only a small effect on longevity such as in the case of mental and behavioural disorders. Diseases of the circulatory system stand out as their elimination would increase life expectancy while reducing health care spending.
  
  
  CONCLUSIONS
  The stronger the negative impact of a disease on longevity, the higher health care costs would be after elimination. Successful treatment of fatal diseases leaves less room for longevity gains due to effective prevention but more room for health care savings.
authors.affiliation: Education and Student Affairs, Technical University, Delft, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Grootjans-van Kampen
authors.affiliation: Centre for Prevention and Health Services Research, Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Engelfriet
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Pieter H M
authors.initials: PH
authors.lastname: van Baal
mesh_terms: D003695:Delivery of Health Care; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D015993:Life Tables; D008297:Male; D009026:Mortality; D009426:Netherlands; D011314:Preventive Health Services