CORRESPONDENCE: LETTER TO THE EDITOR
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George A. Diamond, MD, FACC*,
Sanjay Kaul, MD, FACC and
Prediman K. Shah, MD, FACC
* Division of Cardiology, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, 2408 Wild Oak Drive, Los Angeles, California 90068 (Email: gadiamond{at}pol.net).
Dr. Boyar would make a very creative accountant. He correctly notes that there are downstream costs and benefits associated with any health care proposal but goes on to sweep the initial $11.3 billion cost of screening under the carpet, analyzing only the additional costs encountered during some future "steady state" (the existence of which necessitates a rather unlikely synchrony between the number of subjects entering and leaving the group of test candidates). This is equivalent to valuing the cost of driving only by what you pay for gas while ignoring what you paid to buy the car. You can, of course, obtain a loan to amortize the car’s cost over many years, but you are not going to get the same deal from your local nuclear laboratory (Visa and MasterCard notwithstanding). In general, health care is a cash-and-carry business in which up-front costs must be paid up front. And if the testing itself were spread out over time, the benefits would be similarly spread out. You can’t get something for nothing.
Are there other ways to cut these costs? Although it is unlikely that any nuclear laboratory would further discount the already heavily discounted Medicare price of $800 used in our analysis (1), statins can be had for much less than our average wholesale price of $2 per day. Drive over to the nearest Wal-Mart (you did buy that car, didn’t you?) and you can walk out with an entire month’s supply for only $4. At that price, the annual cost of unconditional treatment falls by over 90% from $10.1 billion to only $0.7 billion—far less than any conditional strategy, even ignoring the initial cost of testing and the implied value of some metaphorical "warranty." If that is not good enough, some health plans are starting to give statins away, believing that the long-term savings will more than offset the short-term costs (2). Maybe you can get something for nothing!
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References
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- Diamond GA, Kaul S, Shah PK. Screen testing: cardiovascular prevention in asymptomatic diabetic patients J Am Coll Cardiol 2007;49:1915-1917.[Abstract/Free Full Text]
- Fuhrmans V. New tack on copays: cutting themEmployers, insurers bet that covering more of the cost of drugs can save money over the long term for chronic conditions. Wall Street Journal 2007:D1May 8.
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