Prevention is better than cure. It’s cheaper too. In fact, preventing future illnesses and preventing complications from existing conditions, are vital to the future sustainability of health systems.
For a vaccine that prevents measles, or a medication that prevents a heart attack, the value is obvious. But what about the value of learning that you are at risk of heart attack? This information could trigger changes in behaviour and lifestyle that reduce the chances of hospitalisation or death.
What about the value of regularly monitoring your blood glucose if you have diabetes? This could prevent profoundly negative (not to mention expensive) complications such as blindness, amputation or stroke.
And what about the value patients and society gets when a clinician knows whether to use an antibiotic – and which one to choose. Not only does this enhance the patient’s chances of a timely recovery, it supports responsible use of antimicrobials and makes better use of resources.
Investing in prevention
With many conditions, earlier intervention improves patient outcomes and spares them – and the health system – avoidable illnesses and treatments. The obvious example is cancer: effective treatment of early stage cancers can dramatically improve prognosis. That’s why screening is so important. Screening is also an example of how population-based prevention programmes can deliver for citizens across the social spectrum, regardless of income or health literacy which can otherwise exacerbate inequality of outcome.
I realise this is not breaking news. Yet less than 3% of health budgets is devoted to prevention. The rest goes on cure and care. I sometimes think we should refer to healthcare as ‘sick care’ – a system focused on ‘healthcare’ would dedicate itself to preserving good health for as long as possible.
As rates of diabetes, heart failure and other chronic conditions continues to rise, and our populations age, it is time that we shifted our thinking to focus on prevention of disease and prevention of disease progression. As an economist, waiting until people get really sick and need costly interventions seems wasteful; as a citizen, it is frightening.
However, I am encouraged by rapid advances in in-vitro diagnostics (IVDs). Clinicians can learn a lot from simple blood and urine tests; advances in genomics mean diagnostic information can inform precision medicine; and sensors are unleashing a revolution in remote monitoring.
My concern is that we continue to view these technologies through the wrong lens. Instead of focusing on the value of information they provide and the potential long-term savings, a short-term perspective on costs prevails. This lack of financing stifles investment in diagnostic tools and the research that leads to future innovations.
VODI – a new approach
The value of diagnostic information (VODI) is the topic of a review article by a large number of international researchers and experts. The group recommends establishing a holistic VODI framework that accounts for the full range of benefits of diagnostic testing for patients, health systems and society.
On the basis of this paper, MedTech Europe organised in October 2019 a workshop in Brussels, where a group of stakeholders representing patients, health professionals and industry discussed the value of diagnostic information, and broadly supported this value concept.
The event reminded us that information provided by diagnostics is vital to clinical decision-making; improves outcomes; makes health systems more efficient; and gives citizens the best opportunity to live active and productive lives – contributing to their families, communities and the wider economy.
The workshop was inspiring but it only heightened my sense of disappointment and frustration that many European countries lack the will to invest in tools that can prevent disease and stop disease progression.
It is time to get serious about capturing the value of diagnostic information. The VODI review paper, and accompanying workshop, was a step in the right direction. Let’s build on this momentum together.