Using
Benefit/Cost Methods in
Prevention Research: The Case of Vitamin E
David
Dranove
Abstract
Two recent cohort studies suggest that supplementation
with vitamin E can reduce the incidence of heart disease by 20%
or more. If so, then a 25% increase in vitamin E consumption by
the U.S adult population could generate annual savings of nearly
$60 billion in reduced medical costs and increased productivity.
If we add on the enormous intrinsic value of improved heatlh outcomes,
the effective savings increase fourfold. The Food and Drug Administration
does not currently permit firms to promote the potential health
benefits of nutritional supplements such as vitamin E, however,
unless and until there is proof of safety and efficacy from randomized
clinical trials.
There are several clinical trials underway, but results
will not be known for at least five years. Even then, the trials
may be inconclusive because they may not detect small improvements
in health status. Because of the enormous benefits of reducing heart
disease, however, even small improvements in health status would
generate savings well in excess of the cost of vitamin E supplementation.
Using Bayesian statistics, I show that the benefits of conducting
two or more additional trials exceed the costs by a factor of eight
or more. Because vitamin E is nonproprietary, the private sector
cannot be expected to conduct these studies. Instead, they must
be funded by goverment agencies like the National Institutes of
Health.
Even if the ongoing trials fail to find a significant
effect of vitamin E, the analysis shows that it might still be cost-effecive
to supplement. If so, a critical issue is whether there are downside
heatlh risks. Given the potential benefits of reducing heart disease,
the relatively low cost of supplementation, and the difficulty of
detecting small improvements in outcomes, the FDA should consider
only requiring proof of safety, rather than safety and efficacy.
David Dranove, Kellogg
Graduate School of Management, Northwestern University
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