Cost effectiveness of prevention - an exploratory study

The concern about prevention programmes being expensive prompted this study into their cost-effectiveness. This report describes preventive health care programmes that are very cost-effective or even cost-saving. By means of semi-structured interviews, 35 Dutch experts in the fields of prevention and/or health economics were asked to provide information on preventive activities that they considered to be cost-effective. Targeted literature searches were performed on the basis of this information. Evidence showing the likelihood of certain prevention programmes being cost-effective or cost-saving led to a thorough examination of the economic evaluation methodology. Only the studies that have adhered to the standards for economic evaluation studies were selected for this report. The experts interviewed listed 30 preventive programmes. For 18 programmes, good quality evidence on cost-effectiveness was found. Some of these programmes are well-known in the Dutch health care system (e.g. PKU test), while others are currently not optimally provided or organised (e.g. folate intake by pregnant women). Some programmes seem especially interesting from an employers' point of view (influenza vaccination of the employed), whereas others have, to date, not been the subject of health-care policy making (e.g. screening for the sexually transmittable bacterium Chlamydia trachomatis). In conclusion, this explorative study demonstrates how the proverb 'an ounce of prevention is worth a pound of cure' may indeed apply to certain preventive health care programmes