SPH and Deakin University have released the Assessing Cost Effectiveness of Prevention (ACE-Prevention) Study, a groundbreaking report with dozens of recommendations that strongly support more spending on prevention, but also warn that not all prevention measures are wise investments.
The project is the result of five years of
research, funded by the National Health and Medical Research
Council. It is the most comprehensive evaluation of health
prevention measures ever conducted world-wide, involving input
from 130 top health experts.
Led by SPH’s Professor Theo Vos and Professor
Rob Carter from Deakin University, the research team assessed
123 illness prevention measures to identify those which will
prevent the most illness and premature deaths and those that are
best value for money.
Among the recommendations to drastically
reduce the rate of serious illness and the associated pressure
on the nation’s health system are:
- a 10 per cent junk food tax
- mandatory salt limits in bread, margarine and cereals
- taxing alcohol at 10 per cent more than the current rate for spirits (to address the tax loophole whereby cask wine is cheaper than soft drink), banning alcohol ads and raising the drinking age to 21
- increased tobacco tax (a further 5 per cent on the April 2010 25 per cent increase) and subsidised smoking cessation aids
- boosting skin cancer awareness with an intense SunSmart campaign
- the introduction of a four-in-one ‘poly-pill’ containing three blood pressure lowering ingredients at a low dose and a cholesterol-lowering drug, available to at-risk individuals and Indigenous people aged 35+ at an affordable price
- screening for early stages of diabetes and chronic kidney disease from age 45, given dialysis treatment costs an average $70,000 per person per year
- lap banding for the severely obese
- bone mineral density tests for older women to identify early stages of osteoporosis
- early intervention screening and better follow-up programs for those with mental health problems, including identifying minor depression in adults and childhood depression and anxiety
- for Indigenous people, screening for early signs of diabetes and chronic kidney disease from age 25.
Professor Vos said, with health and aged care
expenditure projected to grow to $246 billion in 2033, and
health care becoming more expensive with the proliferation of
high-tech treatments, the need to find proven, affordable
illness prevention measures is pressing.
“Governments desperately need reliable
information to use their health budgets more efficiently, so
that they can direct the limited resources to where they have
the best health outcomes. This will ensure best value health
care,” Professor Vos said.
“An
initial investment of $4 billion and less than $1 billion in
following years would be required to put in place the 43 most
cost-effective prevention measures. This would give Australians
an extra million healthy years over their lifetime. The costs
would be more than matched by future savings from not having to
treat disease”.
The ACE-Prevention research team also found
that several preventive health practices currently applied in
Australia have limited benefit and should be reconsidered.
These include inefficient current practice in
cardiovascular preventive treatment with expensive drugs
favoured over cheaper alternatives, prostate-specific antigen
(PSA) testing for prostate cancer, aspirin to prevent heart
disease, weight loss programs and school-based illicit drug
awareness campaigns.
Deakin University’s Prof Rob Carter cautioned
that: “While the economic case to increase funding for health
promotion is strong, it’s important we make tough but necessary
reallocations away from ineffective measures with poor
cost-effectiveness and towards those that we know are more
cost-effective.”
Speaking at the launch in Melbourne today,
Todd Harper, CEO of Australia’s first health promotion
organisation, VicHealth, said: “Public health currently receives
only 2 per cent of the health budget. Governments must place
greater importance on proven prevention strategies to avoid the
massive rise in preventable illnesses in the next few decades.”
Public Health Association of Australia
President Professor Mike Daube added: “By acting now, we could
prevent a million premature deaths among Australians now alive.
The jury is in and we have clear evidence on what works in some
crucial areas. The only real opposition to action will come from
commercial interests. It is up to Governments to take the action
that can keep Australians alive and healthy.”
The ACE-Prevention project was funded by the
NHMRC and is supported by VicHealth, the Public Health
Association of Australia and Lowitja Institute for Aboriginal
and Torres Strait Islander Health Research, (incorporating the
Cooperative Research Centre for Aboriginal and Torres Strait
Islander Health).
Copies of the report and brochures that
clearly outline recommendations for each health topic, are
available at:
www.sph.uq.edu.au/bodce-ace-prevention