Article

Priorities among effective clinical preventive services: results of a systematic review and analysis.

HealthPartners Research Foundation, Minneapolis, Minnesota, USA.
American Journal of Preventive Medicine (Impact Factor: 4.28). 08/2006; 31(1):52-61. DOI: 10.1016/j.amepre.2006.03.012
Source: PubMed

ABSTRACT Decision makers at multiple levels need information about which clinical preventive services matter the most so that they can prioritize their actions. This study was designed to produce comparable estimates of relative health impact and cost effectiveness for services considered effective by the U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices.
The National Commission on Prevention Priorities (NCPP) guided this update to a 2001 ranking of clinical preventive services. The NCPP used new preventive service recommendations up to December 2004, improved methods, and more complete and recent data and evidence. Each service received 1 to 5 points on each of two measures--clinically preventable burden and cost effectiveness--for a total score ranging from 2 to 10. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally.
The three highest-ranking services each with a total score of 10 are discussing aspirin use with high-risk adults, immunizing children, and tobacco-use screening and brief intervention. High-ranking services (scores of 6 and above) with data indicating low current utilization rates (around 50% or lower) include: tobacco-use screening and brief intervention, screening adults aged 50 and older for colorectal cancer, immunizing adults aged 65 and older against pneumococcal disease, and screening young women for Chlamydia.
This study identifies the most valuable clinical preventive services that can be offered in medical practice and should help decision-makers select which services to emphasize.

1 Bookmark
 · 
122 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Based on new efficacy data, we estimate the cost-effectiveness of influenza vaccine options available to US seniors.•We find that high-dose trivalent vaccine is a cost effective alternative to both trivalent and quadrivalent standard-dose influenza vaccines.•Our conclusions are robust in the face of sensitivity analyses.
    Vaccine 11/2014; · 3.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper considers two models (with and without age structure) of sexually-transmitted infections, in order to evaluate the cost-effectiveness of vaccinating by gender. The first model consists of 6 ODEs for the proportions of the population susceptible, infected, and vaccinated, for both males and females. The steady states of this model are found, both with and without vaccination, and the basic reproduction number R 0 is determined. Global stability of steady states is determined. Using parameter values consistent with the US and Canada, it is found that vaccinating only females is the most effective use of a limited amount of vaccine. The second (age-structured) model divides each of the above classes into children, adults and elders. A similar analysis is performed, and again it is found that vaccinating only females is most effective. A sensitivity analysis of 10 parameters is performed.
    Discrete and Continuous Dynamical Systems - Series B 03/2014; 2(2). · 0.63 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aspirin is commonly used for the primary prevention of cardiovascular disease (CVD) in the US. Previous research has observed significant levels of inappropriate aspirin use for primary CVD prevention in some European populations, but the degree to which aspirin is overutilized in the US remains unknown. This study examined the association between regular aspirin use and demographic/clinical factors in a population-based sample of adults without a clinical indication for aspirin for primary prevention. A cross-sectional analysis was performed using 2010-2012 data from individuals aged 30-79 years in the Marshfield Epidemiologic Study Area (WI, USA). Regular aspirin users included those who took aspirin at least every other day. There were 16,922 individuals who were not clinically indicated for aspirin therapy for primary CVD prevention. Of these, 19% were regular aspirin users. In the final adjusted model, participants who were older, male, lived in northern Wisconsin, had more frequent medical visits, and had greater body mass index had significantly higher odds of regular aspirin use (P<0.001 for all). Race/ethnicity, health insurance, smoking, blood pressure, and lipid levels had negligible influence on aspirin use. A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently. There was evidence of aspirin overutilization in this US population without CVD. Older age and more frequent provider visits were the strongest predictors of inappropriate aspirin use. Obesity was the only significant clinical factor, suggesting misalignment between perceived aspirin benefits and cardiovascular risks in this subgroup of patients. Prospective studies that examine cardiac and bleeding events associated with regular aspirin use among obese samples (without CVD) are needed to refine clinical guidelines in this area.
    Clinical Epidemiology 01/2014; 6:433-40.

Full-text (3 Sources)

Download
37 Downloads
Available from
May 27, 2014