Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention

Abstract

PURPOSE Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity.

Strategies to Prioritize Clinical Options in Primary Care

“…In this issue of Annals of Family Medicine, Maciosek et al present compelling evidence that childhood immunizations and efforts to prevent or stop smoking are dominant population health priorities and rank numerous other services based on potential clinical benefit and cost-effectiveness. [3][4][5] Once smoking cessation and immunizations are addressed, however, we are left wondering how to prioritize the other 439 evidence-based clinical services based on their potential benefit to an individual patient.…”

“…We anticipate that further progress may occur as risk prediction science improves, better methods of communicating results to patients in customized ways are devised, and ways of prioritizing clinical options across a broader set of clinical domains are developed. [3][4][5]13,29 To read or post commentaries in response to this article, see it online at http://www.annfammed.org/content/15/1/10. …”

Does Diversity Matter for Health? Experimental Evidence from Oakland

“…The health value estimates come from cost-effectiveness simulations in which the screen-positive population obtains and complies with guideline-recommended therapy. Using this approach, we calculate that black doctors would reduce mortality from cardiovascular disease by 16 deaths per 100,000 per year, accounting for 19 percent of the black-white gap in cardiovascular mortality (Kahn et al 2010;Dehmer et al 2017;Murphy et al 2017;and Harper, Rushani, and Kaufman 2012). If these effects extrapolate to other leading causes of death amenable to primary or secondary prevention, such as HIV/AIDS or cancer, the gains would be even larger.…”

In This Issue: Powerful Ideas for Action

“…Two additional papers use sophisticated microsimulation analyses to identify which preventive options for cardiovascular disease are most effective for the general population and for subgroups, 17 and to examine the separate and collective impact of brief clinician tobacco counseling for youth and for adults. 18 Editorials by David Satcher, 19 George Isham and colleagues, 20 and Patrick O'Connor and colleagues 21 provide complementary and helpful perspectives in understanding this scientific evidence on prioritizing preventive services, and in applying it in policy and practice.…”