Comments on: Encourage Wellness to Reduce Health Care Costs http://catalystleadershipcoaching.com/work-life-balance/encourage-wellness-to-reduce-health-care-costs/ News, commentary, and inspiration for leaders Fri, 21 Nov 2008 03:36:40 +0000 http://wordpress.org/?v=2.5 By: kitty http://catalystleadershipcoaching.com/work-life-balance/encourage-wellness-to-reduce-health-care-costs/#comment-198 kitty Sun, 03 Aug 2008 23:00:45 +0000 http://catalystleadershipcoaching.com/?p=164#comment-198 Short answer: NNS or Number Needed to Screen. While providing incentive to exersize and not smoke is great, this company actually forces people to have tests; tests which aren't even recommended by USPSTF which is a main guideline-setting authority in the US, and which comprises many doctors and epidemiologists who evaluate evidence and check if benefits of a test outweight the risk. But we are talking cost-savings here, not evidence of benefit. And because of NNS this isn't one and the same. With many tests, including those this company does, you need to test thousands, even tens of thousands, to prevent one case of advanced desease. Tests are not perfect. Tests have false positives. After many years of yearly testing, the probability of at least one false positive is very high. Many tests have an issue with "overdiagnosis" i.e. they find early desease which may just never cause any problem if remains undetected. But often, it is not possible to say if the desease will progress, so everyone is treated. Not only can treatment cause serious side-effects, all these screening, false positive evaluation and treatment is expensive. Take for example the blood tests this company does. Aside from an obvious question "do you really want your employer to know about your health risks, even genetic problems?" let's say the blood will show that some slim, active woman (I choose a woman on purpose) has high LDL. The woman is already active, already eats right and exercises, but because of her bad genes - and most cases of high cholesterol are indeed genetic - there is no way she can get the cholesterol down without drugs. But her employer wants her to get her cholesterol down. Since she is in her 40s, slim and healthy, her absolute risk of having a heart attack in 10 years is under 1%. Now, there really is very little if any evidence that statins do any good for primary prevention in women, but for argument say let's assume that it would reduce her risk of a heart attack by 30%. Sounds impressive right? But then her absolute risk of heart attack is only 1%, so reducing this risk by 30% means reducing it from 1% to .7%. Less impressive than 30% reduction, right? How many people like this woman do you need to treat for 10 years to prevent one heart attack? I'll let you figure it out. Do you think it'll save money? Prevention saves money? Really? BTW - New England Journal of Medicine reviewed available studies and concluded that it is not the case. Of course, if the company starts laying off people with risk factors, they'll save money. Is that what you want your employer to do? Or do you want your employer and not your doctor to tell you when to take prescription drugs? Short answer: NNS or Number Needed to Screen. While providing incentive to exersize and not smoke is great, this company actually forces people to have tests; tests which aren’t even recommended by USPSTF which is a main guideline-setting authority in the US, and which comprises many doctors and epidemiologists who evaluate evidence and check if benefits of a test outweight the risk. But we are talking cost-savings here, not evidence of benefit. And because of NNS this isn’t one and the same.

With many tests, including those this company does, you need to test thousands, even tens of thousands, to prevent one case of advanced desease. Tests are not perfect. Tests have false positives. After many years of yearly testing, the probability of at least one false positive is very high. Many tests have an issue with “overdiagnosis” i.e. they find early desease which may just never cause any problem if remains undetected. But often, it is not possible to say if the desease will progress, so everyone is treated. Not only can treatment cause serious side-effects, all these screening, false positive evaluation and treatment is expensive.

Take for example the blood tests this company does. Aside from an obvious question “do you really want your employer to know about your health risks, even genetic problems?” let’s say the blood will show that some slim, active woman (I choose a woman on purpose) has high LDL. The woman is already active, already eats right and exercises, but because of her bad genes - and most cases of high cholesterol are indeed genetic - there is no way she can get the cholesterol down without drugs. But her employer wants her to get her cholesterol down. Since she is in her 40s, slim and healthy, her absolute risk of having a heart attack in 10 years is under 1%. Now, there really is very little if any evidence that statins do any good for primary prevention in women, but for argument say let’s assume that it would reduce her risk of a heart attack by 30%. Sounds impressive right? But then her absolute risk of heart attack is only 1%, so reducing this risk by 30% means reducing it from 1% to .7%. Less impressive than 30% reduction, right? How many people like this woman do you need to treat for 10 years to prevent one heart attack? I’ll let you figure it out. Do you think it’ll save money?

Prevention saves money? Really? BTW - New England Journal of Medicine reviewed available studies and concluded that it is not the case. Of course, if the company starts laying off people with risk factors, they’ll save money. Is that what you want your employer to do? Or do you want your employer and not your doctor to tell you when to take prescription drugs?

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