NNT Labeling and Health Care Costs

Bill Gates, whose Foundation works on health issues worldwide, was recently asked about U.S. spending on health care vs. the rest of the world. He noted that "We spend 17.8 percent of our GNP on health care. [The] next highest [country] is at 12 percent." With health care costs spiraling upwards each year at a rate far in excess of GNP growth, this imbalance is not improving.

Yet, as Bill Gates also noted, "…our outcomes aren't better."

Why is that? For the country as a whole, we appear to be prescribing or taking unnecessary drugs and/or ordering or undergoing unnecessary tests and surgeries. Not only are these drugs and procedures expensive in and of themselves, but they often generate significant collateral expenses to track outcomes and to monitor, and sometimes treat, side effects.

While there is a growing recognition of the problem in specific fields of medicine, there has been little focus on the problem as a whole. Headlines New York papers, over just a few weeks in early 2011, included:

" Studies of Breast Biopsies Finds Surgery Used Too Extensively "
" Ask doc: Is that pricey scan really necessary? "
" Prostate Guideline Said To Cause Useless Biopsies "
" Reports: Many autism treatments lack data "

The key reason we highlight the book Overdiagnosed: Making People Sick in the Pursuit of Health in Suggested Reading is that it shows a consistent pattern of over-diagnosis and treatment over a wide range of medical disciplines.

But not everyone reads books like this. What is needed is a conceptually simple tool to integrate the results of disparate studies on the cost-effectiveness of various drugs and procedures.

We believe that NNT is such a tool. Easy to understand, the concept of Number Needed to Treat lets both doctors and patients explore the rationale for any specific treatment. Perhaps, more importantly, it provides a simple comparative measure of the effectiveness of preventative treatments for a wide range of diseases.

Implementing an NNT labeling requirement on the federal level, or even in a key state or two, could dramatically reverse the trend towards over-diagnosis and over-treatment that has been driving health care expenses in the wrong direction.