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Greater Use of Preventive Services in US Healthcare Could Save Lives at Little or No Cost

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Abstract

There is broad debate over whether preventive health services save money or represent a good investment. This paper analyzes the estimated cost of adopting a package of twenty proven preventive services--including tobacco cessation screening, alcohol abuse screening, and daily aspirin use--against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million life-years annually. What's more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending. These findings suggest that policy makers should pursue options that move the nation toward greater use of proven preventive services.
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... Whether or not utilization of preventive care is cost-effective has been debated by some analysts. However, Maciosek et al. (2010) suggest that increasing the use of preventative care packages to 90% in the population could potentially lead to two million increased years of life each year they are delivered. A preventive care package refers to the adoption of multiple evidence-based clinical preventative services, such as screenings and medication use. ...
... In addition, the cost of implementing these services would later become regained. This is beneficial to payers, insurers, and patients because utilizing groups of preventive care services is cost-neutral and also leads to better health outcomes (Maciosek et al., 2010). ...
... Health care programs, such as the one I am advocating for, can work to eliminate and control non-infectious diseases, including COPD (Bloland et al., 2012). Implementing preventative services like support groups and MI into the usual COPD care pathway is beneficial for payers, insurers, and patients because preventative care in general is cost neutral and also leads to better health outcomes (Maciosek et al., 2010). Beaton (2017) tells us that payers who encourage patients to use preventative services will have lower costs, and the patients who use the services will have a smaller risk of chronic disease development. ...
Thesis
Public health institutions have come a long way in working to eliminate disease, but one that is still threatening the United States (U.S.) health care system is chronic obstructive pulmonary disorder (COPD). COPD is the third highest cause of death globally, which leaves the medical and economic burden at an all-time high. There is a severe delay in diagnosis and treatment, which causes an underutilization of preventative care services. COPD care management is below the standard of quality care, which ultimately causes insufficient outcomes for patients and providers. This information alone is of high public health relevance, and is enough to call for a reform in the COPD treatment care path. Preventative care technique’s ability to be cost effective and their ability to improve overall patient outcomes in COPD patients will be examined thoroughly. The primary aim of this essay is to discuss the potential costs and benefits of including COPD support groups and motivational interviewing (MI) into a regular part of the COPD care pathway. Including these preventative measures into the COPD care pathway is the goal of this research in order to reduce readmissions and improve overall quality of life. Based on this research, the author will advocate to utilize these techniques in a prevention program.
... By and large, preventive medicine seeks to increase an individual's overall health through the instilment of healthy habits (e.g., non-smoking, healthy eating) and the early detection and/or treatment of disease (American College of Preventive Medicine, 2019; Clarke, 1974;Fraser and Shavlik, 2001;Hensrud, 2000). While there is some contention concerning the overall benefit of preventive medical practices (e.g., Salkeld, 1998;Sox, 1994), research has shown that preventive care is associated with better long-term outcomes for patients with diseases such as HIV/AIDS, hepatitis C, and tuberculosis (Bali, 2017;Hensrud, 2000;Patterson and Chambers, 1995), including increased life expectancy (Boulware et al., 2007;Fraser and Shavlik, 2001;Maciosek et al., 2010;Rasmussen et al., 2007). Experts (i.e., the Canadian Task Force on the Periodic Health Examination, U.S. Preventive Services Task Force, and the American College of Physicians) have furthermore agreed that preventive medicine practices such as routine blood pressure and serum cholesterol measurements, vaccinations, and smoking cessation counseling are beneficial for all low-risk patients' long-term health (Sox, 1994). ...
... The benefits of preventive care, especially for high-risk patients such as incarcerated offenders, have been established within the peer-reviewed literature (e.g., Bali, 2017;Boulware et al., 2007;Maciosek et al., 2010;Patterson and Chambers, 1995;Rasmussen et al., 2007). This population does not, however, universally receive such care (Chari et al., 2016;Hughes and Smith, 2018), nor are they necessarily legally able to advocate for their access to it (Friedman, 1992 effectively extending their punishment beyond the scope of that which they were originally sentenced to by the criminal justice system. ...
Article
Incarcerated offenders are categorically high-risk patients who are disproportionately more likely to suffer from chronic illnesses than members of the general population. The conditions of confinement (e.g., overcrowding, poor nutrition, risky sexual practices) furthermore make them increasingly susceptible to acquiring an infectious disease. Past research has linked preventive care, including the early detection and treatment of such diseases, with better long-term health outcomes; however, such care is not universally provided to this population. The benefits and current availability of preventive care for incarcerated offenders is discussed and several questions are raised for future discussion within a global context. In particular, these questions include whether or not incarcerated offenders should receive preventive care, the underlying reason for such provision, who should advocate for and for be responsible for their access to preventive care, and the mechanisms through which access could be attained.
... Medical care spending devoted to the elderly are expected to rise continually. Researches have highlighted the impact of ageing on healthcare spending and urged governments to focus on prevention and treatment [8,9]. Healthcare accounts for a huge part of government fiscal expenditure. ...
... Using Eqs. 8,9,11, and 19 yields the equilibrium prevalence rate of ill health or disease: ...
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Background The proportion of the elderly aged 65 years old or above will reach 16% in 2050 worldwide. Early investment in effective prevention would generally reduce the morbidity, complication, functional disability, and mortality of most chronic illnesses and save resources in both healthcare and social services. This research aims to investigate how the optimal allocation of medical resources between prevention and treatment adds value to the population’s health as well as examine the interaction between ageing, health, and economic performance. Methods This research undertakes ageing-health analyses by developing an economic growth model. Based on the Organization for Economic Co-Operation and Development (OECD) countries’ experiences over the period from 2000 to 2017, this research further examines the hypothesis that an ageing society could increase demand for preventive and curative healthcare. Results Theoretical analysis found that the prevention share for maximizing growth is the same as that for minimizing ill health and maximizing welfare; this share increases with treatment share and ageing ratios. Estimation results from OECD countries’ experiences indicate that when treatment share increases by 1%, the prevention demand increases by 0.036%. A one-percent increase in the ageing ratio yields a change in prevention share of 0.0368%. The optimal share of prevention health expenditure to GDP would be 1.175% when the prevalence rate of ill health isat 6.13%; a higher or lower share of prevention would be accompanied with a higher prevalence of ill health. For example, a zero and 1.358% preventive health expenditure would be associated with an 18.01% prevalence of ill health, while the current share of prevention of 0.237% is associated with a 10.26% prevalence of ill health. Conclusion This study shows that appropriate prevention is associated with decreases in the prevalence rates of ill health, which in turn attains sustainable growth in productivity. Too much prevention, however, could lead to higher detection of new chronic diseases with mild severity, which would result in longer illness duration, and higher prevalence rates of ill health. With suitable allocation of medical resources, the economic growth rate will help to cancel out increases in healthcare spending for the elderly and for expenses needed for the improvement of the population’s health as a whole.
... The rapidly aging population in those countries presents a number of policy challenges, one of the most important of which is increased healthcare costs [2]. To help contain such cost increase, there has been a growing emphasis on health promotion and disease prevention to fight chronic, lifestyle related diseases [3,4] and to help older adults maintain their independence [5]. Health promotion and disease prevention measures targeting the elderly have been shown to not only mitigate the risk of common health issues such as falls but also to improve the socio-psychological well-being of the recipients of those measures [6]. ...
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Background As population aging progresses, volunteers in health field are expected to play a key role in health promotion and disease prevention, which may improve community residents’ health and well-being and at the same time help slow the growth of healthcare cost. The objective of this study is to examine the effects of self-oriented motives and altruistic motives as explanatory factors for Japanese Community Health Workers (CHWs)’ desire to continue their service. Unraveling the relative effects of these two types of motivation on CHW retention may lead to policy and practical implications for recruiting, training, and supporting CHWs in Japan. Haddad (2007) observed that citizens in Japan generally have a sense of governmental and individual responsibility for dealing with social problems. Applying these insights to CHWs, we hypothesize that altruistic motives have more potent influence on volunteers’ willingness to continue to serve than self-oriented motives. Methods Three cities in Shiga prefecture, Japan agreed to participate in the study. Anonymous, self-administered questionnaire was mailed to all CHWs who work in the three communities. The survey data were collected in March and April, 2013. A total of 417 questionnaires were mailed to CHWs, of which 346 were completed and returned (response rate 83.0%). Nine questionnaires missing response to the question concerning willingness to continue serving were removed from the analysis. The final analysis used 337 questionnaires (effective response rate 80.8%). Results One hundred ninety-nine (59.1%) of the respondents answered the question about willingness to continue CHW affirmatively, and 138 (40.9%) negatively. Controlling for other relevant factors, those with self-oriented motives in serving as CHWs were more likely to state they are willing to continue to serve (OR:1.54, confidence interval 1.00–2.37) than those without such motives. Those with altruistic motives were also more likely to say they want to continue their service (OR 1.56, confidence interval 1.08–2.27) than those without such motives. Contrary to our hypothesis, the two motives, altruistic and self-oriented, were shown to have nearly equal degree of influence on respondents’ willingness to continue serving as CHWs. Conclusion One practical implication of the research is that learning more about the twin motives, self-oriented and altruistic, of volunteers and tailoring the content of CHW training by municipal health professionals to address those motives may be beneficial.
... As cancer survivors are at an increased risk for many of the chronic conditions, it is vital that survivors receive appropriate preventive care. Preventive services can save lives and decrease healthcare costs by identifying illnesses earlier, managing them more effectively, and treating them before they develop into complicated, debilitating conditions [2,3]. However, the focus of cancer survivors is likely on receiving cancer care over appropriate non-cancer-related preventive services such as diabetes and cardiovascular disease screenings. ...
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PurposeAdequate access to and utilization of preventive services are vital among cancer survivors. This study examined preventive service utilization of cancer survivors compared to matched patients with no history of cancer among patients seeking care at community health centers (CHCs).Methods We utilized electronic health record data from the OCHIN network between 2014 and 2017. Cancer survivors (N = 20,538) ages ≥ 18 years were propensity score matched to three individuals with no history of cancer (N = 61,617) by age, sex, region, urban/rural, ethnicity, race, BMI, and Charlson Comorbidity Index. Preventive screenings included cancer, mental health and substance abuse, cardiovascular, and infectious disease screenings, and vaccinations. Patient-level preventive service indices were calculated for each screening as the total person-time covered divided by the total person-time eligible. Preventive service rate ratios comparing cancer survivors to patients with no history of cancer were estimated using negative binomial regression.ResultsCancer survivors had higher overall preventive service utilization (incidence rate ratio = 1.11, 95% confidence interval = 1.09–1.13) and higher rates of cancer screenings (IRR = 1.16, 95% CI = 1.12–1.20). There was no difference between the two groups in mental health screenings.Conclusions Cancer survivors were more likely to be up-to-date with preventive care than their matched counterparts. However, mental health and substance abuse screenings were low in both groups, despite reports of increased mental health conditions among cancer survivors.Implications for Cancer SurvivorsWith the growing number of cancer survivors in the USA, efforts are needed to ensure their access to and utilization of preventive services, especially related to behavioral and mental healthcare.
... Further, nearly half of all mental health Communicated by Gregorio Paolo Milani issues manifest in children before the age of 14 and are often related to one's physical health [6]. In addition, childhood health outcomes have significant long-term economic ramifications [7]. ...
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The Cook Partisan Voting Index (PVI) determines how strongly a state leans toward the Democratic or Republican Party in US presidential elections compared to the nation. We set out to determine the correlation between childhood health outcomes and state-level partisanship using PVI. Sixteen measures of childhood health were obtained from several US governmental agencies for 2003–2017. The median PVI for every state was calculated for the same time period. Pearson’s rho determined the correlation between PVI and each health outcome. Multiple regression was also conducted, adjusting for educational attainment and percentage of non-White residents. We also compared childhood health in moderately Democratic and Republican states (5–9.9% more Democratic/Republican than the national mean) and, similarly, for extremely Democratic and Republican states (10% or more Democratic/Republican than the national mean), using Wilcoxon tests. For all 16 health measures, the median values in Democratic-leaning states represented better outcomes than Republican-leaning states (9/16 had a beta value for linear regression associated with P < 0.05). When compared to Republican states, the median values in moderately Democratic states represented better outcomes for 14 of 16 health measures (9/14 associated with P < 0.05). Similarly, the median values for extremely Democratic states represented better outcomes with regard to all 16 health measures, when compared to Republican-leaning states (8/16 associated with P < 0.05). Conclusions: Democratic-leaning states displayed superior outcomes for multiple childhood health measures when compared to Republican counterpart states. Future research should investigate the significance of these findings and attempt to determine which state-level policies may have contributed to such disparate health outcomes. What is Known: • In the United States, many health disparities exist among children along racial, economic and geographic lines. • Many US states lean strongly towards either the Democratic or Republican political parties in federal elections. What is New: • Trends for multiple measures of childhood health vary in association with the political partisanship of the state being examined. • Multiple barometers of childhood health are superior in Democratic-leaning states, while no measures are better in Republican-leaning states.
... Although both the health of the fetus and the economic benefits of protecting the health of the fetus were frequently cited prudential considerations in favor of the prenatal policy, it was uncommon for a supporter of the policy to raise the health benefits to the mother or the subsequent cost savings that could result from increasing the mother's access to preventive care measures like smoking cessation programs and obesity screening. 15,16 The contrast in Nebraska between the vocalized concern for not-yet-born future citizens and the inattention to the health of noncitizen residents of the state illustrates that the morally relevant characteristics that generated an obligation to provide prenatal care were pregnancy with a future citizen and the innocence of the fetus, rather than membership or embeddedness in the social community. ...
Article
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Policy Points • States can create policies that provide access to publicly funded prenatal care for undocumented immigrants that garner support from diverse political coalitions. • Policymakers have used a wide range of moral and practical reasons to support the expansion of care to this population, which can be tailored to frame prenatal policies for different stakeholder groups. Context Even though nearly 6% of citizen babies born in the United States have at least one undocumented parent, undocumented immigrants are ineligible for most public health insurance. Prenatal care is a recommended health service that improves birth outcomes, and some states, including both traditionally “blue” and “red” states, have opted to provide publicly funded coverage for prenatal services for people who are otherwise ineligible due to immigration status. This article explores how courts and legislatures in three states have approached the question of publicly funded prenatal care for undocumented immigrants and its relationship to the abortion debate, with a particular focus on the moral and practical justifications that policymakers employ. Methods We employed a review and qualitative analysis of the documents that comprise the legislative histories of prenatal policies in three case states: California, New York, and Nebraska. Findings This review and analysis of policy documents identified moral reasons based on appeals to different conceptions of moral status, respect for autonomy, and justice, as well as prudential reasons that appealed to the health and economic benefits of prenatal care for US citizens and legal residents. We found that much of the variation in reasons supporting policies by state can be traced to the state's position on the protection of reproductive rights and whether the policymakers in each state supported or opposed access to abortion. Interestingly, despite these differences, the states arrived at similar prenatal policies for immigrants. Conclusions There may be areas where policymakers with different political orientations can converge on health policies affecting access to care for undocumented immigrants. Future research should explore the reception of various message frames for expanding public health insurance coverage to immigrants in other contexts.
Technical Report
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This report begins with data and information from the research literature on health and healthcare disparities for disadvantaged and marginalized groups, including those in rural areas. It then explains telehealth and how it has evolved over time, particularly since the COVID-19 pandemic. After a discussion of the relevant regulatory environment, the paper provides data and relevant research to address the question of whether telehealth has the potential to ameliorate existing health disparities, or conversely, aggravate them. We find that telehealth has substantial potential for reducing health disparities, including the lack of culturally competent care, but this potential is limited by inadequate information and communications technology infrastructure and digital literacy among many disadvantaged groups.
Article
Background There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services. The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide. Methods We conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for five high-burden infectious diseases across the SEAR. Findings A total of 2338 studies were reviewed, and 12 studies were included in our analysis, covering six countries across the SEAR (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, dengue fever). We identified significant disruption to TB testing (range=25% to 77.9%) and diagnoses (range=50% to 58%) in India, Nepal, and Indonesia; and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for dengue fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. No studies were identified for malaria nor hepatitis in any country, and nor for any service in the remaining six SEAR countries. Interpretation We identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and dengue fever due to the COVID-19 pandemic across multiple SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining six SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness. Funding This work was supported by the WHO Sri Lanka Country office.
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One of the main goals of public health insurance expansions is to increase access to health care services, but doing so may require providers to move to previously underserved areas. Whether and to what extent any such relocation occurs remains an open question. I study how providers choose their practice locations in response to Medicaid expansions for one of the most common forms of primary care, dental care services. I find that expansions of adult Medicaid dental benefits increased the number of dentists per capita in poor counties relative to non-poor counties by 13 percent, or 2.8 dentists per 100,000 population. The increase was larger in counties where the expansions generated greater financial incentives for dentists.
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A popular component of the candidates' plans for controlling spiraling health care costs involves greater promotion of preventive health measures. Joshua Cohen, Peter Neumann, and Milton Weinstein write that sweeping statements about the cost-saving potential of prevention, however, are overreaching.
Article
Background: Cost-effectiveness analyses of clinical preventive services are a potential means to aid public health resource allocation. Cost-utility analysis (CUA) is a specific form of cost-effectiveness analysis where results are expressed in terms of cost per quality-adjusted life year (QALY) gained. To increase the transparency and comparability of CUAs, standardization of methods has been recommended.Objectives: The purposes of this study were as follows: (1) identify published articles with original CUAs of primary and secondary clinical preventive services, (2) summarize the ratios found in these analyses, (3) identify articles employing comparable methods, and (4) explore analytic methods employed over time.Methods: As part of a larger study we conducted a comprehensive search of published CUAs in the area of clinical preventive services and systematically collected data on the results of the analyses and analytic methods employed. Cost-effectiveness ratios were standardized and organized into a table.Results: We found 50 CUAs pertaining to clinical preventive services (primary, n=22, 44%; and secondary, n=28, 56%) and 174 cost-effectiveness ratios. These ratios ranged from cost-savings up to $27,000,000/QALY, with a median of $14,000/QALY. Only three (6%) of the CUAs met minimum reference case requirements. There was no apparent improvement of methods over time.Conclusions: Immunizations and chemoprophylaxis have the most favorable cost-effectiveness ratios, and preventive services are more cost-effective when targeted at high-risk populations. However, there is wide variation in the methods used in these analyses. This study allows us to define where improvements in methodologic rigor need to occur, provides a base-line for future audits, and highlights disease areas in clinical preventive services that have been omitted or underevaluated.
Article
We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. “Life-saving interventions” were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs $42,000 per life-year saved. The median medical intervention costs $19,000/life-year; injury reduction $48,000/life-year; and toxin control $2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.
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Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the U.S. We used person-specific data from a representative sample of the U.S. population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the U.S. today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real U.S. population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible. Approximately 78% of adults aged 20-80 years alive today in the U.S. are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by approximately 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced approximately 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the U.S. adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the U.S. population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years. Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the U.S. today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.
Article
We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. "Life-saving interventions" were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs $42,000 per life-year saved. The median medical intervention cost $19,000/life-year; injury reduction $48,000/life-year; and toxin control $2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.
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In this issue of the Journal, Fries et al.1 offer an attractive alternative to health care cost-control proposals such as managed competition, global budgets, rationing, and the like. On behalf of the Health Project Consortium, they propose that wider use of preventive care, broadly defined, would control growth in medical expenditures and make Americans healthier at the same time. Fries et al. are not the first to suggest that prevention saves money -- the idea has enduring appeal. Cost-effectiveness studies, however, provide little evidence of savings. At the same time, the expectation that preventive care will save money may hold . . .
Article
Cost-effectiveness analyses of clinical preventive services are a potential means to aid public health resource allocation. Cost-utility analysis (CUA) is a specific form of cost-effectiveness analysis where results are expressed in terms of cost per quality-adjusted life year (QALY) gained. To increase the transparency and comparability of CUAs, standardization of methods has been recommended. The purposes of this study were as follows: (1) identify published articles with original CUAs of primary and secondary clinical preventive services, (2) summarize the ratios found in these analyses, (3) identify articles employing comparable methods, and (4) explore analytic methods employed over time. As part of a larger study we conducted a comprehensive search of published CUAs in the area of clinical preventive services and systematically collected data on the results of the analyses and analytic methods employed. Cost-effectiveness ratios were standardized and organized into a table.Results: We found 50 CUAs pertaining to clinical preventive services (primary, n=22, 44%; and secondary, n=28, 56%) and 174 cost-effectiveness ratios. These ratios ranged from cost-savings up to $27,000,000/QALY, with a median of $14,000/QALY. Only three (6%) of the CUAs met minimum reference case requirements. There was no apparent improvement of methods over time. Immunizations and chemoprophylaxis have the most favorable cost-effectiveness ratios, and preventive services are more cost-effective when targeted at high-risk populations. However, there is wide variation in the methods used in these analyses. This study allows us to define where improvements in methodologic rigor need to occur, provides a base-line for future audits, and highlights disease areas in clinical preventive services that have been omitted or underevaluated.
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Decision makers want to know which healthcare services matter the most, but there are no well-established, practical methods for providing evidence-based answers to such questions. Led by the National Commission on Prevention Priorities, the authors update the methods for determining the relative health impact and economic value of clinical preventive services. Using new studies, new preventive service recommendations, and improved methods, the authors present a new ranking of clinical preventive services in the companion article. The original ranking and methods were published in this journal in 2001. The current methods report focuses on evidence collection for a priority setting exercise, guidance for which is effectively lacking in the literature. The authors describe their own standards for searching, tracking, and abstracting literature for priority setting. The authors also summarize their methods for making valid comparisons across different services. This report should be useful to those who want to understand additional detail about how the ranking was developed or who want to adapt the methods for their own purposes.
Article
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.
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In 2006, U.S. health care spending increased 6.7 percent to $2.1 trillion, or $7,026 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than in 2005. Prescription drug spending growth accelerated in 2006 to 8.5 percent, partly as a result of Medicare Part D's impact. Most of the other major health care services and public payers experienced slower growth in 2006 than in prior years. The implementation of Medicare Part D caused a major shift in the distribution of payers for prescription drugs, as Medicare played a larger role in drug purchases than it had before.