Study on cost-effectiveness of preventing disease

Landmark Aust. study on cost-effectiveness of preventing disease – New Zealand has much to learn

New Zealand has much to learn from an Australian programme of research on the cost-effectiveness of 150 interventions to prevent or treat disease, according to researchers from the University of Otago, Wellington.

The Australian research, known as “Assessing Cost Effectiveness in Prevention”, or ACE-Prevention for short, is being launched in Melbourne today.

“Some of the Australian study results can be generalised confidently to the New Zealand setting, and in some cases the New Zealand context is different – but we can still apply the method to New Zealand data to generate our own findings,” says Professor Tony Blakely, Director of the recently funded Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme.

The ACE-Prevention Report, prepared jointly by the University of Queensland and Deakin University, finds that many prevention programmes are not only cost effective, but actually save money by preventing future health care expenditure.

General findings that the New Zealand researchers think are applicable now to New Zealand include:
• Increasing alcohol tax results in substantial health gains and savings. More targeted alcohol interventions – like licensing controls and brief patient interventions that are currently favoured by the New Zealand Government – are considered a reasonable option, but they are “no where near as effective as a population-wide intervention such as higher taxation”.
• Nutrition education targeted towards individuals and programmes such as Weight Watchers are found to be no where near as effective as taxes on fatty foods, and mandatory reductions in the salt content of processed food. From a New Zealand context, “this would support taking the GST off healthy food as opposed to health education messages to improve nutrition” says Professor Blakely.
• Switching people at risk of heart disease to lower cost medications would save billions of dollars in Australia, and achieve further health gains. There is probably some applicability to New Zealand says colleague Associate Professor Nick Wilson “although we have already progressed further down this path than Australia due to the efforts of Pharmac and others to lower costs”. One very promising option that has not been implemented in either Australia or New Zealand yet is a polypill, an ‘all-in-one’ pill that includes small doses of four medicines that reduce the chance of developing heart disease.
• Most obesity prevention interventions did not stack up well, except personalised education and – controversially – laparoscopic banding surgery for severely obese people.

More generally, a common theme in the Australian report across all health problems was that regulation, taxation and population-wide programmes tended to have the biggest health gains, and the greatest chance of cost savings.

“A responsible and canny state that alters the provision and price of healthy living – be that access to cheaper effective medicines or cheaper healthy diets – is usually the best option for both improving the nation’s health, and freeing up health care funding for other uses,” says Professor Blakely.

Professors Blakely and Wilson and their research team at the University of Otago, Wellington, will be building on this Australian work over the next five years. “We have Health Research Council funding that will allow us to adapt this research to New Zealand data, and to interventions that are unique or different in New Zealand.”

“A particular focus of our work will be to look at how to best spend health dollars to improve Māori health and the health of the poorest New Zealanders, and how to balance the competing priorities of efficiency and equity.”

The Australian researchers have pioneered assessing cost-effectiveness of interventions among Indigenous Australians. They found that screening for and early treatment of kidney disease is very important for Indigenous Australians. “In New Zealand, similarly focused analyses for Māori needs conducting, but the findings are likely to be different due to varying disease profiles,” says Professor Blakely.

As countries face high expectations for healthcare spending and with aged care expenditure projected to grow – decisions will also need to be made on dropping less cost-effective treatments. The ACE-Prevention research team also found that several preventive health practices currently applied in Australia have limited benefit and should be reconsidered. These include inefficient current practice in cardiovascular preventive treatment with expensive drugs favoured over cheaper alternatives, and prostate-specific antigen (PSA) testing for prostate cancer.

Speaking at the launch in Melbourne today, Deakin University’s Professor Rob Carter cautioned that: “While the economic case to increase funding for health promotion is strong, it’s important we make tough but necessary reallocations away from ineffective measures with poor cost-effectiveness and towards those that we know are more cost-effective.”

Public Health Association of Australia President Professor Mike Daube added: “By acting now, we could prevent a million premature deaths among Australians now alive. The jury is in and we have clear evidence on what works in some crucial areas. The only real opposition to action will come from commercial interests. It is up to governments to take the action that can keep Australians alive and healthy.”

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