A two-sided model of what adding life-years does to a public health budget. Avoided acute and chronic-disease care (the prevention saving) is set against the cost of funding additional life-years of medical and long-term care; quality-adjusted life-years (QALYs) are valued separately. A morbidity-compression control lets you test whether prevention makes the added years cheaper. Defaults reproduce the standard result (van Baal 2008): cost-effective, not cost-saving.
| Avoided acute care (saving) | |
|---|---|
| Avoided chronic-disease care (saving) | |
| Added medical care (cost) | |
| Added long-term care (cost) | |
| Net fiscal impact | |
| QALYs gained | |
| Value of QALYs gained | |
| Net cost per QALY |
Crediting avoided chronic-disease care is correct and necessary — but it is exactly what the prevention-economics literature already does, and the net is still typically a cost. Preventing the disease does not make the patient cost-free; it lets them live the added years to develop a different expensive condition (dementia, cancer, frailty), and the costly terminal year is deferred, not deleted (van Baal 2008; Bonneux 1998). The model only flips to a net saving when avoided-disease costs exceed the full cost of the added life-years — which generally requires strong morbidity compression, an empirical claim, not a given.
Structural tension: the more life-years an intervention adds, the more care it funds, so strongly life-extending prevention is the cost-increasing kind. The model still flatters the case — it treats avoided costs as fully avoided rather than deferred, uses average not terminal-spike costs, and omits pensions/OAS/GIS. The defensible claim is cost-effectiveness and the value of healthy life, not an OHIP line-item saving. Not for clinical or policy use.