Plain Language Summary

What is it about?

Healthcare spending in the United States has grown substantially, but whether Americans receive good value remains unclear. This is important because the United States spends more per person than other wealthy nations while achieving lower life expectancy. The specific problem researchers addressed was understanding which diseases and injuries receive healthcare spending that produces meaningful health improvements and which do not. Previous research examined only adults aged 65 and above, leaving a gap about healthcare value across all ages. This paper offers a comprehensive method tracking both spending and health improvements for 132 causes across the entire lifespan. This study demonstrates that healthcare value varies dramatically across conditions and that spending increases often occur at younger ages while health improvements appear later.

How was the research conducted?

The basic concept was simulating what would happen if 2016 healthcare technology were applied to the 1996 population. Researchers used "cause replacement" to isolate improved rates per case from changes in the number of cases. They assumed that changes in rates measured the effects of healthcare technology, and changes in the number of cases measured the effects of health risks like smoking and other factors. They calculated health-adjusted life expectancy, accounting for both lifespan and quality, and lifetime spending, representing total healthcare costs. This data analysis combined information from the Global Burden of Disease study, which tracked deaths and disability, and the Disease Expenditure study, which tracked spending. Researchers studied population-level data for all ages, examining 132 causes.

What were the results?

Healthcare improvements between 1996 and 2016 increased health-adjusted life expectancy by 1.285 years per person while increasing lifetime spending by $234,111, costing $182,201 per health-adjusted year gained. Seventy-nine causes showed increases in both health and spending with substantial variation: HIV/AIDS treatment cost only $9315 per health-adjusted year gained, while heart disease cost $63,184. Surprisingly, drug use disorders decreased health-adjusted life expectancy by 0.331 years, offsetting other gains and raising overall costs to $182,201 per health-adjusted year gained from $144,689 without this cause.

Why are the results important?

These results identify where healthcare dollars work effectively and where improvements are needed. Findings could change policy by directing attention toward causes with poor value, particularly drug use disorders. Patients with conditions showing good value, such as HIV/AIDS and heart disease, benefit from effective treatments, while policy makers can prioritize research for conditions with poor value. Long-term impacts include better resource allocation and improved population health as healthcare focuses on high-value interventions.

What are the strengths and weaknesses of this study?

This study's strength is providing the first comprehensive estimates across all ages for 132 causes, revealing that spending increases at younger ages while health improvements appear later. The main weakness is the way that the authors addressed clinical risk factors, such high blood pressure, that can be modified with healthcare. They allocated spending on clinical risk factors to people with the diseases, whereas a more complete analysis would account for both the number of cases and the effects on people with the disease. Follow-up studies could distinguish whether younger-age spending represents valuable long-term investments and incorporate the full effects of risk factors.

^{Note: This content was created with assistance from artificial intelligence (AI) and has been reviewed and edited by ISPOR staff. For more information or for inquiries on ISPOR’s AI policy, click here or contact us at info@ispor.org.}