Article Figures & Data
Tables
Score CPBa Range: QALYb Saved, Undiscounted CEc Range: $/QALY Saved, Discounted 5 >700,000 Cost-saving 4 190,000–700,000 0–3,500 3 70,000–190,000 33,500–50,000 2 18,000–70,000 50,000–75,000 1 <18,000 >75,000 CE = cost-effectiveness; CPB = clinically preventable burden; QALY = quality-adjusted life year.
↵a A measure of the health impact of a preventive service.
↵b Years saved if the clinical preventive services were delivered at recommended intervals to a US birth cohort of 4 million patients during the years of life for which a service was recommend.
↵c Measure of efficiency of the service in producing health improvement.
Services (Short Name) Description CPB CE Total Childhood immunization series ACIP childhood immunization seriesa 5 5 10 Tobacco use, brief prevention counseling, youth Provide interventions to prevent initiation, including education or brief counseling 5 5 10 Tobacco use screening and brief counseling, adults Screen adults for tobacco use and provide brief cessation counseling and pharmacotherapy 5 5 10 Alcohol misuse screening and brief intervention Screen adults’ misuse and provide brief counseling to reduce alcohol use 3 5 8b Aspirin chemoprevention for those at higher risk of CVD Low-dose aspirin use for primary prevention of CVD in adults ages 50–59 y with ≤10%, 10-y CVD risk and other factors 3 5 8 Cervical cancer screening Screen for cervical cancer in women aged 21 to 65 y with cytology (Papanicolaou smear) every 3 y 4 4 8 Colorectal cancer screening Screen adults aged 50–75 y routinely 4 4 8b Chlamydia and gonorrhea screening Screen for chlamydia and gonorrhea in sexually active women aged ≤24 y, and in older women at increased risk for infection 3 4 7b Cholesterol screening Screen routinely for lipid disorders men aged >35 y, and screen younger men and women of all ages who are at increased risk of CHD. Treat with lipid-lowering medications 4 3 7 Hypertension screening Measure blood pressure routinely in all adults and treat with antihypertensive medication to prevent the incidence of CVD 4 3 7 AAA screening Screen men aged 65–75 y who have ever smoked 1 time for abdominal aortic aneurysm, using ultrasonography 2 4 6b Healthy diet and physical activity counseling for those at higher risk of CVD Offer or refer adults who are overweight or obese with additional CVD risk factors to intensive behavioral counseling to promote healthful diet and physical activity 5 1 6 HIV screening Screen for HIV infection in adolescents and adults aged 15 to 65 y. Frequency varies by risk level 2 4 6b HPV immunization Administer a 3-dose series of HPV vaccine to all girls aged 11–12 y 3 3 6 Influenza immunization, adults Immunize all adults against influenza annually 4 2 6b Obesity screening, adults Screen all adults routinely for obesity. Refer patients with a BMI of ≥30 kg/m2 to intensive behavioral interventions 5 1 6b Syphilis screening Screen all persons at increased risk for syphilis infection 1 5 6 Vision screening, children Screen children routinely between ages 3 and 5 y to detect amblyopia 2 4 6b Breast cancer screening Biennial mammography for women aged 50–74 y; screening before age 50 y an individual decision 3 2 5b Depression screening, adolescents Screen adolescents aged 12–18 y for depression with systems to assure accurate diagnosis, treatment, and follow-up 2 3 5b Depression screening, adults Screen adults for depression with systems to assure accurate diagnosis, treatment, and follow-up 3 2 5b Obesity screening, children and adolescents Screen children aged ≥6 y for obesity. Offer or refer obese children to comprehensive, intensive behavioral intervention 4 1 5 Pneumococcal immunization, adults Immunize adults aged >65 y against pneumococcal disease with PCV13 and PPSV23 2 3 5b Herpes zoster immunization Single dose of vaccine for adults aged >60 y 1 3 4 Osteoporosis screening Screen women aged >65 y and younger women whose fracture risk is equal to or greater than that of white women aged 65 y with no additional risk factors 2 2 4 Folic acid chemoprevention Women planning or capable of pregnancy should take a daily supplement with 0.4–0.8 mg of folic acid 1 2 3 Meningococcal immunization Single dose of quadrivalent vaccine recommended for children aged 11 to 12 y, with a booster at age 16 y 1 1 2 Tdap/Td booster One time Tdap and Td booster every 10 y 1 1 2 AAA = abdominal aortic aneurysm; ACIP = Advisory Committee on Immunization Practices; BMI = body mass index; CE = cost-effectiveness; CHD = coronary heart disease; CPB = clinically preventable burden; CVD = cardiovascular disease; HIV = human immunodeficiency virus; HPV = human papillomavirus; PCV13 = pneumococcal conjugate vaccine—13 pneumococcal serotypes; PPSV23 = pneumococcal polysaccharide vaccine—23 pneumococcal serotypes; Td = tetanus, diphtheria; Tdap = tetanus, diphtheria, and pertussis.
↵a Estimate includes all recommended vaccines up to 10 years of age (diphtheria, tetanus, pertussis; measles, mumps, rubella; inactivated polio virus; Hemophilus influenzae type b; hepatitis A; hepatitis B; varicella; pneumococcal conjugate; influenza; and rotavirus) plus influenza vaccination to age 18 years.
↵b Sensitivity analysis indicated that a change of score of 2 or more is possible.
Services (Short Name)a Source Currently Receiving Services Nationallyb % Additional QALY Saved if Currently Receiving Services Increased to 90%c Services with utilization data available Tobacco use counseling to prevent initiation by youthd Jamal23 20 530,000 Tobacco use screening and brief cessation intervention, adults NCQA24
Jamal25
King2650 460,000 Alcohol misuse screening, brief intervention McKnight-Eily27 10 140,000 Colorectal cancer screening CDC28 65 110,000 Influenza immunization, adults CDC29 45 100,000 HPV immunizationd Reagan-Steiner30 50 59,000 Breast cancer screening NCHS31
CDC2875 42,000 Chlamydia and gonorrhea screeningd CDC32 40 39,000 HIV screening Chandra33 20 32,000 Aspirin chemoprevention for those at higher risk of CVD Williams34 50 30,000 Cervical cancer screening NCHS31
CDC2885 14,000 Vision screening, children Kemper35 75 5,000 Pneumococcal immunization, adults CDC28 70 4,000 Services with utilization data assigned at 50% Obesity screening, adultse Assigned 50 540,000 Healthy diet counseling for those at higher risk of CVDe Assigned 50 300,000 Obesity screening, children and adolescentsd,e Assigned 50 78,000 Depression screening, adultse Assigned
Farr36
Edwards3750 45,000 AAA screeninge Assigned
Shreibati3850 21,000 Depression screening, adolescentsd,e Assigned 50 11,000 Syphilis screeninge Assigned 50 2,000 AAA = abdominal aortic aneurysm; CDC = Centers for Disease Control and Prevention; CMS = Centers for Medicare & Medicaid Services; CPS = Community Preventive Services; CVD = cardiovascular disease; FDA = Food and Drug Administration; HIV = human immunodeficiency virus; HPV = human papillomavirus; QALY = quality-adjusted life years; USPSTF = US Preventive Services Task Force.
↵a See Table 2 for a description of each service. Childhood immunizations, hypertension screening, and cholesterol omitted from table because of current high utilization rates.
↵b Current utilization rates rounded and reflect approximate average of male and female patients, across all relevant age-groups and other important groups for a service, such as groups at high and low risk for disease.
↵c Indicates additional lifetime QALYs saved if 90% of a cohort of 4 million were offered service as recommended.
↵d Youth services estimated based on a target of 90% of youth receiving service annually, although slightly less than 90% of adolescents aged 12–17 years saw a health care professional in 2012.
↵e Based on limited utilization data. Utilization data were considered limited if existing information was difficult to use to quantify utilization rates and place an upper boundary more precise than 50%. Either utilization data are completely lacking or are available only for a population for which generalizability to US population is highly questionable, or the utilization measures available are poorly aligned with the preventive service as recommended by the USPSTF.
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The Article in Brief
Updated Priorities Among Effective Clinical Preventive Services
Michael V. Maciosek , and colleagues
Background The National Commission on Prevention Priorities has updated its 2006 rankings of 28 clinical preventive services. The Commission used sophisticated microsimulation modeling to estimate the relative health impact and cost-effectiveness of each service. The findings are intended to assist clinicians and other decision-makers in their efforts to plan quality improvement initiatives, develop performance measurements, build primary care medical homes, and incorporate preventive services into the contracts of accountable care organizations.
What This Study Found The three highest ranking preventive services are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Other high-ranking services include alcohol misuse screening with brief intervention; discussing aspirin use with high-risk adults; screenings for colorectal cancer, cervical cancer, chlamydia and gonorrhea, cholesterol, hypertension, and obesity; healthy diet counseling for those at a higher risk of cardiovascular disease; abdominal aortic aneurysm screening in high risk men; HIV screening; human papillomavirus immunization; influenza immunization; syphilis screening; and vision screening for children.
Implications
- There are substantial opportunities for primary care to improve population health through increased implementation of these evidence-based services.
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