to prevent coronary heart disease,* 48 $191,635
per year for diet/exercise to prevent diabetes in
high-risk adults† and $30,619 per year for
biennial mammograms to screen for cancer
among women ages 50 to 79.^49
Screening pregnant women who smoke can be
especially cost effective, given that the smoking-
attributable medical care needed by infants
whose mothers smoked while pregnant is an
estimated $367 million per year.‡ 50 A one-
percent reduction in the prevalence of smoking
in the U.S. population, including among
pregnant women, would reduce the number of
low-birth weight births by 2,000,§ resulting in
$21 million in avoided direct medical costs.
Continuing at that rate for another six years,
more than 57,000 low-birth weight births could
be prevented, saving $572 million.^51
The American Legacy Foundation projected that
a reduction in Medicaid costs of nearly one
billion dollars** could be achieved by preventing
the current cohort of 24-year-olds†† from
smoking. If prevention and cessation efforts
were successful in motivating all Medicaid
recipients who smoke to quit, states’ Medicaid
expenditures would be, on average, 5.6 percent
lower, resulting in a total of $9.7 billion in
savings after five years.^52
Risky Alcohol Use. Screening and brief
intervention for risky alcohol use rank among
the top most cost-effective prevention services
available,^53 along with colorectal cancer
- For 45-year old men with a 10-year risk for
coronary heart disease of 7.5 percent. The
calculation includes the cost of medication plus
medical care including care for adverse events (e.g.,
Aspirin-induced gastrointestinal bleeding and
resulting morbidity and mortality).
† Costs include individually-tailored diet and exercise
plans, visits to a nutritionist and physical training
sessions.
‡ In 1996 dollars.
§ Based on 1995 birth rates.
** Over the cohort’s lifetime.
†† The researchers chose this age because nearly all
smokers begin smoking before age 24, whereas
younger smokers may still be experimenting with
tobacco.
screening, hypertension screening and influenza
immunization.^54Research findings suggest that early
interventions‡‡ for risky alcohol use may result
in health care cost savings of up to $43,000 for
every $10,000 invested.^55 A study of primary
care screening and brief physician intervention
for adult risky drinkers yielded a net benefit of
$947 per person.^56The use of screening and brief interventions in
hospitals has demonstrated promising returns on
investment.^57 A study of screening and brief
interventions for risky alcohol use among adults
in trauma centers estimated that over a three-
year period, the cost savings associated with
screening were $89 per patient§§ and the cost
savings associated with brief interventions
lasting 30 minutes were $330 per patient.*** In
total, the implementation of a hospital-based
alcohol screening and brief intervention program
for risky alcohol use was estimated to reduce
health care costs by $3.81 for every dollar
spent.^58 Brief interventions††† with adolescents
ages 18 and 19 who were admitted to a trauma
center for alcohol-related injuries also have been
found to be more cost-effective than standard
care.^59The return on investment in preventing Fetal
Alcohol Syndrome (FAS) further underscores
the importance of screening and early
interventions. The added medical costs for a
child with FAS are estimated to be more than
$2,300 per year for the first 21 years of a child’s
life. An alcohol intervention program costing
$50,000 that could successfully prevent at least
one case of FAS annually would pay for itself in
just six years.^60‡‡ Consisting of two doctor visits and two nurse
follow-up calls.
§§ Cost per screening was $16.
*** Cost per intervention was $38. Savings were
calculated based on average hospitalization and
emergency department costs; hospital recidivism
rates for trauma patients with and without addiction
involving alcohol; and the efficacy rate of screening,
brief interventions and referrals to treatment at
reducing injury, recidivism and hospital readmission.
††† Using motivational interviewing.