By Iris Smith, Ph.D.

“An ounce of prevention is worth a pound of cure” (Benjamin Franklin, 1735), is a familiar maxim and a fundamental tenet of the field of prevention science.  The challenge for prevention professionals and researchers is measuring the proverbial “ounce” and the “pound.”

Cost-benefit or cost-effectiveness analyses are usually used to demonstrate the societal value of an evidence-based intervention, using agreed upon criteria for “benefit” and “effectiveness.”  However, “benefits” and “effectiveness” may vary depending on values and perceptions of worth among researchers and program stakeholders.  In prevention, we consider a program to be effective if it results in a measurable and desired change in a problematic outcome, for example, the prevalence of substance use within an adolescent population or the number of opioid involved overdose deaths. From a societal perspective, it is also important to consider the benefits, potential harms, and the cost of the intervention relative to the resource expenditure required for prevention compared to the “burden” of the prevention focus (condition we are trying to prevent). 

Using opioid use disorder (OUD) as an example, the most frequently used outcome in effectiveness studies is the prevalence of opioid involved deaths.  However, OUD also impacts both physical and mental quality of life compared with the general population including sleep disturbances, transmittable diseases, and health outcomes related to criminal activity such as gun violence.[1] In 2014, opioid overdoses were responsible for 147,654 emergency department (ED) admissions at a cost of $152.8 million, with over half these costs ($83.7 million) borne by the public sector.  The mean annual excess of healthcare costs for an individual patient with OUD has been estimated at $14,054 to $20,546.[2] In 2017 the U.S. government spent more than 740 billion in costs related to crime, lost work, and health care for opioid users. These costs continue to grow each year. Recently the CDC released new data showing that overdose deaths have more than doubled from 2019-2021.[3]

Alcohol is another example. Alcohol consumption has been linked to 200 types of injuries, infectious and chronic diseases and crime (such as DUIs and homicide).  In some countries alcohol is the primary risk factor for death and disability in individuals between 15 and 49. [4] A 2019 systematic review of mathematical models used to measure the societal burden of alcohol use and the cost effectiveness of targeted public health interventions, grouped models based on methodology into 3 groups:  state transition models that estimate transitions in disease-related states or risk factors to determine population impact of an intervention; disease-analytic models that estimate  incidence, prevalence, remission, mortality based on population life tables; and population attributable and preventable fraction models in which risk factors are selected based on the level of evidence for a causal relationship to alcohol use and the relevancy of the risk factors for population health.[5]

There is no question that alcohol and other drug use has a wide-ranging impact on individuals, families, and communities resulting in significant economic costs for many sectors of society.  Data on economic costs provides a more complete picture of the societal burden of alcohol and other drug use and strong rationale in support of the “ounce” of prevention.

Resources

Barbosa C, Dowd WN, Zarkin G ()2020).  Economic Evaluation of Interventions to Address Opioid Misuse:  A Systematic Review of Methods Used in Simulation Modelling Studies. Value in Health Journal, 23 (8); pg1096-1108. https://www.valueinhealthjournal.com/article/S1098-3015(20)32064-7/fulltext?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1098301520320647%3Fshowall=true

Bardach AE, Alcaraz AO, Ciapponi A, Garay OU, Riviere AP, Palacio A, Cremonte M, Augustovski F. (2019).Alcohol Consumption’s Attributable Disease Burden and Cost-Effectiveness of Targeted Public Health Interventions:  A Systematic Review of Mathematical Models.  British Medical Journal 19; pg. 1378-1393. https://doi.org/10.1186/s12889-019-7771-4

Hagemeir NE (2018) Introduction to the Opioid Epidemic:  The Economic Burden on the Healthcare System and Quality of Life.  American journal of Managed Care 24(10); pg. 200-206.  https://www.ajmc.com/view/intro-opioid-epidemic-economic-burden-on-healthcare-system-impact-quality-of-life

Pradhan AM, Park L, Shaya FT, Finkelstein J (2019) Consumer Health Information Technology in the Prevention of Substance Abuse:  Scoping Review.  Journal Medical Internet Research, 21(1); e1197. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372939/