One of our easy assumptions is that effective prevention will lead to significant savings in the public purse.
I’ve often pointed to the lifetime cost of problematic drug misuse or to the modelling that NICE commissioned that shows how a “£75 million [alcohol education] programme would be cost effective provided it led to at least a 1.4% reduction in alcohol consumption among young people.”
But this paper suggests we may need to take some care when making these arguments.
Looking at smoking cessation interventions the authors argue:
Savings on health-care spending in early years after people stop smoking are counter-balanced (often exceeded) by higher spending at a later time. In addition, when people stop smoking there is a significant negative impact on government finances from the double effect of lost tax revenues combined with increased spending on pension payments.
Does that mean we stop trying to prevent deaths from smoking? No, but it may mean making different arguments which focus on improvements to population health outcomes rather than straight cost benefit ratios.