Nichol M. Edwards

Primary Care Intervention to Reduce Alcohol Misuse : Ranking Its Health Impact and Cost Effectiveness

BACKGROUND The U.S. Preventive Services Task Force (USPSTF) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse. This study was designed to develop a standardized rating for the clinically preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services. METHODS A systematic review of the literature from 1992 through 2004 to identify relevant randomized controlled trials and cost-effectiveness studies was completed in 2005. Clinically preventable burden (CPB) was calculated as the product of effectiveness times the alcohol-attributable fraction of both mortality and morbidity (measured in quality-adjusted life years or QALYs), for all relevant conditions. Cost effectiveness from both the societal perspective and the health-system perspective was estimated. These analyses were completed in 2006. RESULTS The calculated CPB was 176,000 QALYs saved over the lifetime of a birth cohort of 4,000,000, with a range in sensitivity analysis from -43% to +94% (primarily due to variation in estimates of effectiveness). Screening and brief counseling was cost-saving from the societal perspective and had a cost-effectiveness ratio of

Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost

1755/QALY saved from the health-system perspective. Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving. CONCLUSIONS These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using standardized methods. Since current levels of delivery are the lowest of comparably ranked services, this service deserves special attention by clinicians and care delivery systems.

Prioritizing Clinical Preventive Services: A Review and Framework with Implications for Community Preventive Services

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. Whats more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of

CA7-03: Adolescent and Adult Immunizations: Health Impact and Cost-Effectiveness.

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.

PS1-65: Relationships Matter! Modeling Segregation and Social Networks to Evaluate Prevention Services for STDs

Setting priorities on the basis of factors such as health impact and economic value is the key first step to ensure that the most important services receive the most attention. Few prioritization efforts have been published that produce either rankings or information that can guide decision making. We propose a framework to help decision makers and clinicians balance short-term demands against long-term objectives. This framework provides guidance for decisions about scope, prioritization criteria, evidence review methods, evaluation of criteria fit, and presentation of results. The framework is the result of our experience setting priorities among clinical preventive services. It has not been tested in prioritizing community interventions and other health care services but should provide a useful starting point for designing priority-setting efforts in those areas.

Priorities Among Effective Clinical Preventive Services : Results of a Systematic Review and Analysis

Background/Aims The scope of vaccines recommended for adolescents and adults by ACIP has grown in number of vaccines and populations covered. We estimated the relative health impact and cost-effectiveness of these vaccines to help guide quality improvement initiative decisions. Methods Markov deterministic and micro-simulation models were used to estimate the health impact and CE ratios for birth cohorts of four million using a societal perspective. All models used methods consistent with the ‘reference case’ of the Panel of Cost-Effectiveness in Health and Medicine, producing results that are comparable and suitable for ranking. The influenza model recognized the 2010 ACIP recommendation for universal vaccination. The pneumococcal model recognized the recent decline in adult incidence after introduction of the PCV7 childhood vaccine. The meningococcal model included the 2010 ACIP recommendation for a booster five years after an initial vaccination at age 11 or 12. The HPV model estimated the influence of vaccine on rates of cervical cancer with and without cancer screening. Parameter estimates were from published literature. Single- and multiple-variable sensitivity analyses were performed. Results Health impacts, measured as QALYs saved during the lifetime of the cohort, were greatest for influenza vaccine (283,300), followed by HPV vaccine with screening (221,100), pneumococcal vaccine (17,100) and meningococcal vaccine (2,900). CE ratios ranged from

Repeated tobacco-use screening and intervention in clinical practice : Health impact and cost effectiveness

9,300 for adult pneumococcal vaccination to over

Influenza Vaccination. Health Impact and Cost Effectiveness Among Adults Aged 50 to 64 and 65 and Older

640,000 for adolescent meningococcal vaccination. CE of influenza vaccination for ages 18 and older was

Colorectal Cancer Screening. Health Impact and Cost Effectiveness

6,100, but the vaccine was most cost-effective for ages 65 and older (

Priorities among effective clinical preventive services: methods.

4,000) and least cost-effective for ages 18 to 49 (