How much to invest in evidence-based, cost-effective prevention?

In Australia, as globally, preventable diseases are one of the major causes of ill health and premature mortality. The most recent study conducted by the Australian Institute for Health and Welfare found that over one-third of this disease burden was preventable and due to well known modifiable risk factors such as smoking and/or obesity.

The good news is that we already have a long list of preventive interventions that we know are both effective and cost-effective (some are even cost-saving) in terms of reducing the burden of ill health and premature mortality associated with these well known modifiable risk factors.

Here we set out to demonstrate the potential impact on Australia’s future health outcomes, and the associated cost, of simply doing what we already know can work.

What we did

We estimated how much it would cost the Australian Government if we invested in a broad range of cost- effective preventive interventions that have already been assessed in the Australian context. There have been a series of studies focusing on prevention that have adopted the Assessing Cost-Effectiveness (ACE) approach to priority setting. Here we combine these studies as they are largely comparable due to the use of similar approaches and data sources in the modelling.

Based on the ACE studies undertaken as part of ACE Prevention (including risk factors for non-communicable disease and mental health), ACE Obesity Policy and a recently conducted study undertaken for the National Mental Health Commission, we updated the costs of all interventions that met the criteria for being cost-effective (either cost-saving or whose incremental cost-effectiveness ratio fell below $50 000 per disability‐adjusted life years averted) to 2017–2018 dollars using the health price deflators published by the Australian Institute of Health and Welfare.

We found that the total cost of the total package of interventions was around $7.2 billion, with a projected $2.7 billion of cost savings (largely to the health sector). Therefore, the net cost to the Australian Government of investing in all the interventions that have been found to be cost-effective within the Australian context would be $4.5 billion, which is just 2% of the total health expenditure in 2017–2018.

The 54 interventions included in these estimates included a range of both adult and child obesity interventions (such as reduced television advertising of unhealthy foods to standing desks in the workplace), a range of taxes (eg, on alcohol, sugary drinks, unhealthy foods), interventions to improve physical activity and reduce salt intake, and a number of interventions targeting mental health, including parenting interventions and school-based psychological interventions. While all interventions had some levels of effectiveness upon which to model cost-effectiveness, the strength of this evidence varied ranging from gold standard multiple randomised controlled trials that could be evaluated using meta-analytical techniques to lower quality before-and-after studies.

Conclusion

This brief analysis has found that investing in what we currently know to be effective and cost-effective interventions within the Australian context is likely to cost 2% of the total health budget and deliver substantial health benefits to Australians. However, it is important to consider that not all preventive interventions have been evaluated using the ACE methodology. For example, interventions targeting prevention in the dental health space have not been comprehensively included, but have been found to be cost-effective and could be included in the 5% target for preventive spending.

At a time of rising costs and expectations of our health care system, we argue that it is vital to prioritise value for money health investments in prevention that deliver effective and sustainable health outcomes for future years.

Cathy Mihalopoulos is currently Professor of Health Economics and Head and Chair of Deakin Health Economics at the Institute for Health Transformation and School of Health and Social Development, Deakin University.

Todd Harper is CEO of Cancer Council Victoria

Marj Moodie AM is Alfred Deakin Professor and Deputy Head of Deakin Health Economics at the Institute for Health Transformation and School of Health and Social Development, Deakin University.

Joahna Perez is a Research Fellow in Deakin Health Economics at the Institute for Health Transformation and School of Health and Social Development, Deakin University.

Anna Peeters is Chair in Epidemiology and Equity in Public Health and Director, Institute for Health Transformation, Deakin University.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.