The break-even point: when medical advances are less important than improving the fidelity with which they are delivered

Woolf, S. H.

doi:10.1370/afm.406

Cited by 208Healthcare cost, quality, practicesHealth Systems, Economic Evaluations, Quality of LifePharmaceutical Economics and Policy

The break-even point: when medical advances are less important than improving the fidelity with which they are delivered

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Woolf, S. H.·2005·The Annals of Family Medicine

DOI 10.1370/afm.406PMC PMC1466946

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Abstract

Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealistic increases in efficacy to do more good than could be accomplished by improving fidelity. In 2 examples (the development of anti-platelet agents and statins), we show that enhanced efficacy failed to achieve the health gains that would have occurred by delivering older agents to all eligible patients. Society's huge investment in technological innovations that only modestly improve efficacy, by consuming resources needed for improved delivery of care, may cost more lives than it saves. The misalignment of priorities is driven partly by the commercial interests of industry and by the public's appetite for technological breakthroughs, but health outcomes ultimately suffer. Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care.

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Behavioural interventions to increase fidelity of intervention delivery have the potential to bring about as great, or greater, health gains than medical advances on their own.
“Behavioural interventions to increase fidelity of intervention delivery have the potential to bring about as great, or greater, health gains than medical advances on their own.177”
From Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data) (2015) · cites this paper as [177]

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Authors: Woolf, S. H.
Affiliations: Virginia Commonwealth University (US)
Corresponding author: Woolf, S. H.
ORCID: Woolf, S. H.
Venue: The Annals of Family Medicine
Publisher: Annals of Family Medicine
Published: 2005-11-01
Volume: 3
Issue: 6
Pages: 545-552
ISSN: 1544-1709 (ISSN-L)
1544-1717
DOI: 10.1370/afm.406
PMC: PMC1466946
OpenAlex: W2100334459
Cited by: 208
References: 90
Citations by year: 2026: 2 · 2025: 2 · 2024: 5 · 2022: 10 · 2021: 4 · 2020: 7 · 2019: 7 · 2018: 13 · 2017: 10 · 2016: 15 · 2015: 12 · 2014: 10 · 2013: 7 · 2012: 17
FWCI: 29.48
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: other-oa
Locations: The Annals of Family Medicine (publishedVersion, other-oa)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
Keywords: health care delivery systems, drug efficacy, antiplatelet agents, statins, health gains, health care costs, health policy priorities, nomogram
MeSH terms: Biotechnology, Delivery of Health Care, Drug Therapy, Health Priorities, Humans, Quality of Health Care, Treatment Outcome, Resource Allocation

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The break-even point: when medical advances are less important than improving the fidelity with which they are delivered

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