Cost Saving vs. Cost Effective

In Wednesday's class, we talked about cost effectiveness compared to cost saving.  For instance, it is cost EFFECTIVE to do mammography to prevent premature deaths from breast cancer -- in that it costs less than $40,000 per quality adjusted life year saved. (This depends a bit on context -- how old the woman is, pretest probability, and previous mammogram).   The good news about doing more mammograms is that fewer women will die prematurely of breast cancer.   However, there are no savings available - we're just spending our resources to buy something of real value.

There are very few things we do in the "medical industrial complex" that are cost SAVING.  I mentioned that from my perspective it was hard to name anything beyond childhood immunization and antiretrovirals for patients with full-blown AIDS.   Class member Ben Geisler has pointed me to the Tufts cost effectiveness registry. 

Ben has found a number of other medical approaches that do seem to be cost saving:

- Hip pads to prevent fractures in high risk nursing home residents
-TB testing and treatment for chinese immigrants to US in year 2000
- Gemfibrozole (cholesterol agent) for men with known  cardiac disease
-Antiosteoporosis treatment for older women at VERY high risk
- Alpha interferon for hep C in 45 year old man (I am dubious on this one myself)
- Acyclovir therapy for herpes zoster and chickenpox in limited populations(I'm dubious here too)
-Leg angioplasty for a very specific population to relieve rest pain in legs

Note that in all instances these are VERY limited populations!

Remember you always have to ask "cost saving compared to what?"  For instance, it might be cost effective to use Viagra instead of a penile implant -- but Viagra can never be cost saving within the health care system compared to no therapy at all!