Cost-Effectiveness and Opportunity Costs

  • Robert M. Kaplan
Are we using our resources wisely in the pursuit of better population health—that is, the general health of our entire population? In order to address this question, we must consider the implications of purchasing healthcare. A good starting point is the comparison of medical decisions and healthcare expenditures in the USA and other countries. While many assume that greater expenditure results in greater health benefit, developed countries that spend considerably less on healthcare in comparison with the USA have about equal health outcomes. Per capita expenditures on healthcare in the UK, for example, are about 40 percent of the per capita expenditures in the USA. As difficult as it may be to believe, life expectancy in the UK is slightly higher than it is in the USA, and infant mortality is slightly lower. Figure 9.1summarizes life expectancy for men and women in seven countries that participate in the Organization for Economic Development and Cooperation. (OECD is an...


Secondary Prevention Infant Mortality Heart Attack Lifestyle Intervention Smoking Prevention 
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  1. 1.
    Starfield B. Is US health really the best in the world? JAMA. 2000;284(4):483–485.CrossRefGoogle Scholar
  2. 2.
    Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Aff (Millwood). 2004;Suppl Web Exclusive:W184–W197.Google Scholar
  3. 3.
    Wennberg JE, Fisher ES, Skinner JS. Geography and the debate over Medicare reform. Health Aff (Millwood). 2002;Suppl Web Exclusives:W96–W114.Google Scholar
  4. 4.
    McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. Jun 26 2003;348(26):2635–2645.CrossRefGoogle Scholar
  5. 5.
    Dolinar RO, Leininger SL. Pay for performance means compliance-based care. J Am Med Dir Assoc. Jun 2006;7(5):328–333.CrossRefGoogle Scholar
  6. 6.
    Deyo RA. Cascade effects of medical technology. Annu Rev Public Health. 2002;23:23–44.CrossRefGoogle Scholar
  7. 7.
    Gilmer T, Kronick R. It’s the premiums, stupid: projections of the uninsured through 2013. Health Aff (Millwood) 2005.Google Scholar
  8. 8.
    Liberman A, Rubinstein J. Health care reform and the pharmaceutical industry: crucial decisions are expected. Health Care Manag (Frederick). Mar 2002;20(3):22–32.Google Scholar
  9. 9.
    The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA. 1984;251(3):351–364.CrossRefGoogle Scholar
  10. 10.
    The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA. 1984;251(3):365–374.CrossRefGoogle Scholar
  11. 11.
    Golomb BA. Cholesterol and violence: is there a connection? [see comments]. Ann Intern Med. 1998;128(6):478–487.Google Scholar
  12. 12.
    Kaplan RM. Behavior as the central outcome in health care. Am Psychol. 1990;45(11): 1211–1220.CrossRefGoogle Scholar
  13. 13.
    Galbraith JK. The Affluent Society. Boston: Houghton Mifflin; 1958.Google Scholar
  14. 14.
    Sullivan DF. Conceptual problems in developing an index of health. Washington: US Dept. of Health Education and Welfare Public Health Service; 1966.Google Scholar
  15. 15.
    Kaplan RM, Bush JW. Health-related quality of life measurement for evaluation research and policy analysis. Health Psychol. 1982;1(1):1–20.Google Scholar
  16. 16.
    Kaplan RM, Alcaraz JE, Anderson JP, Weisman M. Quality-adjusted life years lost to arthritis: effects of gender, race, and social class. Arthrit Care Res. 1996;9(6):473–482.CrossRefGoogle Scholar
  17. 17.
    Kaplan RM. The Ziggy theorem: toward an outcomes-focused health psychology. Health Psychol. 1994;13(6):451–460.CrossRefGoogle Scholar
  18. 18.
    Fahs M, Mandelblatt J. Cost-effectiveness of cervical cancer screening among elderly low-income women. In: Goldbloom R, Lawrence R, eds. Preventing Disease: Beyond the Rhetoric. New York: Springer-Verlag; 1990:441–446.Google Scholar
  19. 19.
    Krahn MD, Mahoney JE, Eckman MH, Trachtenberg J, Pauker SG, Detsky AS. Screening for prostate cancer: a decision analytic view. JAMA. Sep 14 1994;272(10):773–780.CrossRefGoogle Scholar
  20. 20.
    Mooney MM, Mettlin C, Michalek AM, Petrelli NJ, Kraybill WG. Life-long screening of patients with intermediate-thickness cutaneous melanoma for asymptomatic pulmonary recurrences: a cost-effectiveness analysis. Cancer. Sep 15 1997;80(6):1052–1064.CrossRefGoogle Scholar
  21. 21.
    Kaplan R, Anderson J. The general health policy model: an integrated approach. In: Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. New York: Raven; 1996:309–322.Google Scholar
  22. 22.
    Goldman L, Weinstein MC, Goldman PA, Williams LW. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA. Mar 6 1991;265(9):1145–1151.CrossRefGoogle Scholar
  23. 23.
    Fisher ES, Welch HG. Avoiding the unintended consequences of growth in medical care: how might more be worse? JAMA 1999;281:446-453.Google Scholar
  24. 24.
    Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. Mar 14 2006;174(6):801–809.CrossRefGoogle Scholar
  25. 25.
    Misra A, Alappan NK, Vikram NK, et al. Effect of supervised progressive resistance-exercise training protocol on insulin sensitivity, glycemia, lipids, and body composition in Asian Indians with type 2 diabetes. Diabetes Care 2008;31:1282–1287.Google Scholar
  26. 26.
    Netz Y, Zach S, Taffe JR, Guthrie J, Dennerstein L. Habitual physical activity is a meaningful predictor of well-being in mid-life women: a longitudinal analysis. Climacteric 2008;11:337–344.Google Scholar
  27. 27.
    Oldridge NB. Economic burden of physical inactivity: healthcare costs associated with cardiovascular disease. Eur J Cardiovasc Prev Rehabil 2008;15:130–139.Google Scholar
  28. 28.
    Muller-Riemenschneider F, Reinhold T, Nocon M, Willich SN. Long-term effectiveness of interventions promoting physical activity: A systematic review. Prev Med 2008.Google Scholar
  29. 29.
    McAndrew LM, Musumeci-Szabo TJ, Mora PA, et al. Using the common sense model to design interventions for the prevention and management of chronic illness threats: from description to process. Br J Health Psychol 2008;13:195–204.Google Scholar
  30. 30.
    Dishman RK, Saunders RP, Motl RW, Dowda M, Pate RR. Self-efficacy moderates the relation between declines in physical activity and perceived social support in high school girls. J Pediatr Psychol 2008.Google Scholar
  31. 31.
    Boutelle KN, Jeffery RW, French SA. Predictors of vigorous exercise adoption and maintenance over four years in a community sample. Int J Behav Nutr Phys Act 2004;1:13.Google Scholar
  32. 32.
    Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008;40:181–188.Google Scholar
  33. 33.
    Singh GK, Kogan MD, Siahpush M, van Dyck PC. Independent and joint effects of socioeconomic, behavioral, and neighborhood characteristics on physical inactivity and activity levels among US children and adolescents. J Community Health 2008;33:206–216.Google Scholar
  34. 34.
    Hatziandreu EI, Koplan JP, Weinstein MC, Caspersen CJ, Warner KE. A cost-effectiveness analysis of exercise as a health promotion activity. Am J Public Health 1988;78:1417–1421.Google Scholar
  35. 35.
    Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care. Sep 2003;26(9):2518–2523.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Robert M. Kaplan
    • 1
  1. 1.UCLA School of Public HealthLos AngelesUSA

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