The "Paradox of Prevention" Framework: Reconciling Massive Population Gains with Marginal Cost-Effectiveness Ratios

Wanjau et al.'s Kenya obesity study revealed interventions yielding millions of HALYs and billions in savings, yet standard CEA would still label these as "cost-saving" rather than transformative. This research proposes a "Prevention Impact Multiplier" framework that quantifies secondary societal benefits (e.g., productivity gains, intergenerational health effects, reduced inequality) alongside traditional QALYs. Unlike Gold's foundational CEA methods, this approach would weight interventions by their scale of population impact rather than per-capita efficiency. It directly addresses why interventions like sugar taxes or digital health tools face adoption barriers despite societal wins. The model could revolutionize HTA for public health policies by aligning economic metrics with real-world value.

References:

1. Cost-effectiveness in health and medicine. M. Gold (2016).
2. The health and economic impact and cost effectiveness of interventions for the prevention and control of overweight and obesity in Kenya: a stakeholder engaged modelling study. M. Wanjau, Lucy W. Kivuti-Bitok, L. Aminde, J. L. Veerman (2023). Cost Effectiveness and Resource Allocation.