Once again, the prevention debate has been polluted by a flawed study whose flawed presentation and flawed discussion undermined its own purpose, which was to encourage the Congressional Budget Office to take a longer time horizon when calculating the benefits of prevention.

The study, posted today on the Health Affairs website, found little long-term savings to overall health care costs from aggressively treating pre-diabetics and diabetics under 65 with blood sugar control medications. The Washington Post, which appears to have been the only media outlet given an advanced copy of the study, led its prominent coverage (headline "Study Raises Questions About Cost Savings From Preventive Care," with the conclusion that preventive services "are unlikely to generate the kind of fantastic savings that President Obama and other Democrats have said could help pay for an overhaul of the nation's health system."

Let's take a look at what was actually in this sophisticated modeling exercise.

The study, which was funded by Novo Nordisk Inc., showed that finding and treating patients who were pre-diabetic (overweight and obese with elevated blood sugar levels) would in fact be cost-effective over the next 25 years IF those patients were under 40. The overall health care expenditures for this younger group, which would include the cost of the stepped up screening and blood sugar control meds (the only prevention strategy analyzed), would decline compared to doing nothing. It wasn't much - just $6 billion saved out of a future health care tab of $312 billion or 1.9 percent - but it was something.

For older persons (age 41 to 64), on the other hand, the intervention cost money. But, again, it wasn't much. Total diabetes-related costs if nothing was done came to $445 billion; add in prevention and the total tab was $15 billion more, an increase of 3.3 percent.

But that presentation of the data ignored the shift that was going on in the composition of care. The total cost of the prevention strategy for every age group was about $20 billion over 25 years. The reduced "sick care" expenses, on the other hand, was all over the map. The youngest cohort (under 30) would actually see their health care expenses over the next quarter century reduced by a whopping $27 billion; those who began the prevention strategy between 41 and 50 would only save $5 billion in health care expenses; begin screening people over 60 and the 25-year savings in reduced health care costs pop back up to $16 billion - nearly as much as the prevention intervention.

If anything, this study was a strong argument for targeting this particular prevention strategy to only the very young or those on the cusp of going into Medicare. Too bad it wasn't presented that way.

There was also an incorrect assumption in the study that will actually work against its being useful to CBO. The report assumed "that the additional costs of stepped-up treatment of diabetes would be financed with additional federal resources."

Why? The population under consideration ranged from ages 24 to 64. Wouldn't most of those people over a good part of the 25-year time horizon receive insurance coverage from their employers or buy it on their own? Doesn't that mean that the costs of prevention would be borne mainly by private insurers or out-of-pocket? Meanwhile, the study does point out that most of the savings would accrue to Medicare, since most of the serious complications of diabetes only come after decades of poorly or untreated high blood sugar and usually result in permanent disability.

It seems to me that a more accurate analysis of the payer incidence for prevention would have bolstered the case for CBO scoring it as a major cost-saver for Medicare and Medicaid.

Finally, the study erred in limiting its prevention strategy to the single choice of stepped up screening followed by drug therapy. Why did it ignore the Diabetes Prevention Program (DPP) created by the National Institutes of Health, which also involved "clinical information to project federal health care spending" (the title of the Health Affairs article)? The architects of the DPP's intensive lifestyle counseling approach have published a peer-reviewed study showing it be far more cost effective at reducing the long-term costs of diabetes than intervening with drug therapy.

After a careful search of the Health Affairs study and its footnotes, I found not a single reference to this taxpayer-financed research. Even a casual PubMed search of this topic would have revealed that there is a heated debate in the medical literature between the authors of the NIH program and the modelers used in this current study, who were also funded by a drug company. How did the numerous peer reviewers mentioned at the end of the article miss this obvious oversight?

Those of us concerned about health care cost controls have to cast the same clear-eyed gaze at prevention strategies as we do at wasteful medical procedures. This is one area where I've done that homework.

CBO should know there is significant evidence suggesting that intensive lifestyle counseling for people on the road to diabetes, if properly targeted, can have a significant impact on long-term health care costs. Moreover, most of those benefits will accrue to Medicare, which winds up paying most of the freight for the horrible complications that result from the improper management of this debilitating disease.

This is one arena where the age-old bromide, "an ounce of prevention is worth a pound of cure," remains true.