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domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md
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@ -41,13 +41,13 @@ The claim that budget scoring "systematically" undervalues prevention requires e
### Additional Evidence (confirm) ### Additional Evidence (confirm)
*Source: [[2024-11-01-aspe-medicare-anti-obesity-medication-coverage]] | Added: 2026-03-16* *Source: 2024-11-01-aspe-medicare-anti-obesity-medication-coverage | Added: 2026-03-16*
The CBO vs. ASPE divergence on Medicare GLP-1 coverage provides concrete evidence: CBO projects $35B in additional spending (2026-2034) using budget scoring methodology, while ASPE projects net savings of $715M over 10 years using clinical economics methodology that includes downstream event avoidance. The $35.7B gap between these estimates demonstrates how budget scoring rules structurally disadvantage preventive interventions. CBO uses conservative uptake assumptions and doesn't fully count avoided hospitalizations and disease progression within the 10-year window, while ASPE includes 38,950 CV events avoided and 6,180 deaths avoided. Both are technically correct but answer different questions—budget impact vs. clinical economics. The CBO vs. ASPE divergence on Medicare GLP-1 coverage provides concrete evidence: CBO projects $35B in additional spending (2026-2034) using budget scoring methodology, while ASPE projects net savings of $715M over 10 years using clinical economics methodology that includes downstream event avoidance. The $35.7B gap between these estimates demonstrates how budget scoring rules structurally disadvantage preventive interventions. CBO uses conservative uptake assumptions and doesn't fully count avoided hospitalizations and disease progression within the 10-year window, while ASPE includes 38,950 CV events avoided and 6,180 deaths avoided. Both are technically correct but answer different questions—budget impact vs. clinical economics.
### Additional Evidence (challenge) ### Additional Evidence (challenge)
*Source: [[2025-01-01-gimm-hoffman-chw-rct-scoping-review]] | Added: 2026-03-18* *Source: 2025-01-01-gimm-hoffman-chw-rct-scoping-review | Added: 2026-03-18*
IMPaCT's $2.47 Medicaid ROI within the same fiscal year demonstrates that at least one category of preventive intervention (CHW programs) generates returns fast enough to be captured within annual budget cycles, not just 10-year windows. This suggests the scoring methodology problem may be less severe for interventions with rapid return profiles. IMPaCT's $2.47 Medicaid ROI within the same fiscal year demonstrates that at least one category of preventive intervention (CHW programs) generates returns fast enough to be captured within annual budget cycles, not just 10-year windows. This suggests the scoring methodology problem may be less severe for interventions with rapid return profiles.