Abstract
PURPOSE The Patient Protection and Affordable Care Act’s provisions for first-dollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services.
METHODS We assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures—cost-effectiveness and clinically preventable burden—for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally.
RESULTS The 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesity-related behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations.
CONCLUSIONS This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives.
- disease, prevention & control
- health services
- economics
- prioritization
- health impact
- cost-effectiveness
- cost-savings
- immunization
- mass screening
- behavioral counseling
Footnotes
Conflicts of interest: authors report none.
Funding support: Support for this study was received from the Centers for Disease Control and Prevention (Cooperative Agreement Numbers 5H25PS003610 and U58/CC0322077-02-01), Robert Wood Johnson Foundation, WellPoint (now Anthem) Foundation, HealthPartners Institute for Education and Research, and American Heart Association.
Disclaimer: The contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
Previous presentations: Draft presented during private webinar of the National Commission on Prevention Priorities on Nov 13, 2015, CDC staff on Apr 14, 2016 and Oct 18, 2016, AHRQ staff on July 11, 2016, and at the APHA Annual Meeting Nov 2, 2016.
Supplementary materials: Available at http://www.AnnFamMed.org/content/15/1/14/suppl/DC1/.
- Received for publication April 19, 2016.
- Revision received September 16, 2016.
- Accepted for publication October 9, 2016.
- © 2017 Annals of Family Medicine, Inc.