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

Overview

In this systematic review, the National Commission on Prevention Priorities evaluated each of the 25 clinical preventive services recommended by the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices. The purpose of this review was to identify which specific services most warrant additional attention aimed at improving physician practices. Three services – aspirin use, tobacco counseling and childhood immunization – were prioritized based on their potential for reducing both health burden and health care costs.

Methodology

For each preventive service, the authors evaluated: 1) the overall burden of disease and 2) the likely benefits of intervention, taking into account the potential disease burden, the extent to which the service is not consistently provided currently, and the costs of the intervention. As an example, for colorectal cancer screening, they considered the prevalence of colorectal cancer in the general population and estimated the overall burden of colorectal cancer that could be alleviated through better cancer screening. They also accounted for the costs of screening compared with the costs of treating the cancers that would be missed without screening.

They calculated the number of quality adjusted life-years (QALYs) that each preventive service could save if delivered to a hypothetical general population of 4 million people. To assess cost-effectiveness, they estimated the cost of providing the preventive service to the population, compared with the extra cost of treating the disease if the preventive service were not provided. They scored each preventive service according to the number of QALY’s saved, on a scale of 1 to 5, as well as with the net cost, also on a scale of 1 to 5. Several interventions proved to be cost-saving, in that their cost was outweighed by the decreased cost of treating the prevented disease, but most services cost more than they saved.

Results

  • Three underused services were prioritized based on their ability to reduce disease burden (as measured in increased QALYs) and reduce costs to the health care system if provided more often:

    • Discussion of aspirin use with high-risk adults

    • Administration of childhood immunizations

    • Screening for tobacco-use combined with brief intervention

  • The authors suggest that these three services represent important targets for health policy where attention to improving services could have large benefits.

  • While other preventive services saved QALYs in the hypothetical model, they did not do so as efficiently or as cost-effectively as compared to discussion of aspirin use, administration of childhood immunizations and tobacco screening.

Conclusions

  • Three services – aspirin use, tobacco counseling and childhood immunization – were prioritized based on their potential for reducing both health burden and health care costs.

  • These three services are priorities for action because of their potential to improve public health. Expanded efforts to improve the discussion of aspirin use between patients and doctors could generate large benefits at a societal level.

  • While potential improvement of other preventive services was found to have benefits, they did not do so as efficiently or as cost-effectively.