Workshop Explores Economics of Prevention
The Precision Medicine Initiative and the Affordable Care Act recognize the value of disease prevention. As NIH expands its efforts in the field, there is growing appreciation of the importance of economic approaches for effectiveness evaluation and intervention design.
To survey recent progress and set future goals, the NIH Health Economics Common Fund Program and the Office of Disease Prevention (ODP) sponsored a recent workshop on economics of prevention.
Participants included directors and deputy directors of NIA, NIMH, NIAMS, ODP and OBSSR and representatives from HHS, CDC and other ICs. Among the speakers were several health economics program grantees. Discussions centered on preventive services utilization, preventive interventions, behavioral economics and intervention evaluation.
In opening remarks, Dr. David Murray, NIH associate director for prevention, emphasized the role of health economics research in advancing NIH’s mission. Dr. Richard Frank, a prominent health economist and current HHS assistant secretary for planning and evaluation, delivered the keynote presentation. He contrasted harms reduction with reduction of use as means of curtailing social costs of tobacco, drugs and other substances.
Dr. Ya-Chen Tina Shih, chief of the section of cancer economics and policy at MD Anderson Cancer Center and a health economics program grantee, analyzed the cost-effectiveness of breast cancer screening in various age groups. Her microsimulation models indicate that broad coverage yields small average gains in health at relatively high cost. Introduction of an effective new breast cancer drug could further reduce mammography’s cost-effectiveness.
Modeling a policy’s consequences is critical to forecasting its impact. Franco Sassi, head of the Organisation for Economic Co-operation and Development Public Health Programme and an NIAAA grantee, urged NIH to invest more in developing shareable models, including those supported by “big data.”
Dr. David Kent, director of predictive analytics and the Comparative Effectiveness Center at Tufts Medical Center and recipient of an NIH health economics award, noted that average results from clinical trials do not reflect individual response variation. Risk-based analysis can help better target preventive interventions.
In the area of behavioral economics, participants noted that small incentives, or “nudges,” can be as effective as large-scale incentives, particularly among low-income groups. Dr. David Laibson, chair of the economics department at Harvard University, discussed the utility of behavioral nudges, such as active choice and default options, for helping individuals act on their intentions for healthy behaviors.
Social factors can provide strong incentives. Dr. Jason Doctor, associate professor at the University of Southern California, reported that the best remedy for the end-of-day rise in inappropriate antibiotic prescriptions is to compare physicians’ prescription rates with peers’ rates.
The meeting concluded with a discussion of future research needs in the economics of prevention led by Dr. John Cawley, professor in the department of policy analysis and management and the department of economics at Cornell University.
A complete meeting summary is available at https://commonfund.nih.gov/healtheconomics/meetings.—Andrey Kuzmichev