New Study Looks At CBO Scoring of Diabetes Prevention

A study published yesterday in Health Affairs has re-generated buzz around Congressional Budget Office (CBO) scoring of chronic disease prevention. Co-authored by former HHS and CBO officials Michael O’Grady and Jim Capretta (who also authored a recent PFCD white paper on the subject) and two University of Chicago professors of medicine, the study specifically looked at type 2 diabetes. You can read the specifics of the study here. Essentially, it looked at direct medical spending and focused solely on federal budget impact of these preventive efforts. While it’s good to look at long-term savings, as this study did, we seem to be stuck on the false idea that well-designed prevention efforts only bring savings in the long-term. The fact is that there are effective lifestyle interventions that have proven to reduce cost in the short run, and these types of efforts can play an important role in the cost debate this fall. For instance, structured lifestyle interventions at the YMCA, based on the model of the national Diabetes Prevention Program (DPP) have shown a 58% reduction in the incidence of diabetes, with cost savings within 2 to 3 years, if the direct costs of the intervention can be reduced to $250 - $300 per year. Additionally, the study, like many others, doesn’t consider the indirect costs of preventing disease – which is too bad considering that most of the burden of chronic disease is linked not to direct health care costs, but the indirect costs of lost productivity. Indirect costs are important to consider in any study that wants to truly capture to cost savings potential of prevention. One of the few studies to look at the indirect cost of chronic disease was published by the Milken Institute in 2007 (and is cited in this Health Affairs piece). That study found that 4/5th of the burden of chronic illness is linked to indirect costs, and that the U.S. loses $1 trillion annually due to lost productivity from the top seven most common chronic diseases. It suggests that we could save over $1.1 trillion in the year 2023 if we better prevented and managed these conditions. So there are two bottom lines. The first is that we need to not just look at interventions that take a long time to produce substantial savings, but also at short-term interventions that can generate savings within a few years. The lifestyle program pioneered by the DPP and now applied in community based settings is one example of cost-saving interventions that produce results within 3 years. The second is that CBO scores legislation only as it impacts the federal budget, and so the length of the window is not the only issue. We also need to look at how the cost of treating chronic disease is affecting the U.S. economy through lost productivity and missed work days. Whether we can reduce those costs will also determine how much savings we can generate.