COMMUNITY PREVENTION STRATEGIES IN THE LITERATURE

EXAMPLES OF COST-EFFECTIVENESS ANALYSES OF
COMMUNITY PREVENTION STRATEGIES IN THE LITERATURE

  1. Chirikos TN, Herzog TA, Meade CD, Webb MS, Brandon TH. Costeffectiveness
    analysis of a complementary health intervention: the case of
    smoking relapse prevention. International Journal of Technology
    Assessment in Health Care. 2004; 20(4):475-480.
    Objectives: We assessed the cost-effectiveness of smoking relapse prevention
    interventions designed to keep quitters from resuming the use of cigarettes. Because
    relapse prevention is complementary to smoking cessation efforts, the appropriate test of
    its cost-effectiveness is whether it reduces the incremental cost-effectiveness ratio (ICER) of
    smoking cessation. The major goal of the study is to carry out such a test.
    Methods: Data from a randomized trial that ascertained the effectiveness of alternative
    modes of smoking relapse prevention were combined with ICER estimates of smoking
    cessation to assess whether relapse prevention is cost-effective.
    Results: The trial produced convincing evidence that relapse prevention yields statistically
    significant reductions in the proportion of quitters who are smoking at 24 months post-quit.
    The intervention effects are substantial enough to raise the denominator terms of the
    smoking cessation ICER and, thereby, offset the amount relapse prevention adds to cost
    numerator terms. In this sense, smoking relapse prevention tends to pay for itself.
    Conclusions: Smoking relapse prevention is a highly cost-effective addition to current
    efforts to curb cigarette consumption. Complementary health interventions of this type
    should be assessed by different methods than those commonly found in the costeffectiveness
    literature.
  2. Curry SJ, Grothaus LC, McAfee T, Pabiniak C. Use and cost-effectiveness of
    smoking-cessation services under four insurance plans in a health
    maintenance organization. NEJM. 1998; 339(10):673-679.
    Background: Lack of information about the effect of insurance coverage on the demand for
    and use of smoking-cessation services has prevented wide-scale adoption of coverage for
    such services.
    Methods: In a longitudinal, natural experiment, we compared the use and costeffectiveness
    of three forms of coverage with those of a standard form of coverage for
    smoking-cessation services that included a behavioral program and nicotine replacement
    therapy (NRT). The study involved seven employers and a total of 90,005 adult enrollees.
    The standard plan offered 50% coverage of the behavioral program and full coverage of
    NRT. The other plans offered 50% coverage of both the behavioral program and NRT
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    (reduced coverage), full coverage of the behavioral program and 50% coverage of NRT
    (flipped coverage), or full coverage of both the behavioral program and NRT.
    Results: Estimated annual rates of use of smoking cessation services ranged from 2.4%
    (among smokers with reduced coverage) to 10% (among those with full coverage).
    Smoking cessation rates ranged from 28% (among users with full coverage) to 38%
    (among those with standard coverage). The estimated percentage of all smokers who would
    quit smoking per year as a result of using the services ranged from 0.7% (with reduced
    coverage) to 2.8% (with full coverage). The average cost to the health plan per user who
    quit smoking ranged from $797 (with standard coverage) to $1,171 (with full coverage).
    The annual cost per smoker ranged from $6 (with reduced coverage) to $33 (with full
    coverage). The annual cost per enrollee ranged from $0.89 (with reduced coverage) to
    $4.92 (with full coverage).
    Conclusions: Use of smoking cessation services varies according to the extent of coverage,
    with the highest rates of use among smokers with full coverage. Although the rate of
    smoking cessation among the benefit users with full coverage was lower than the rates
    among users with plans requiring co-payments, the effect on the overall prevalence of
    smoking was greater with full coverage than with the cost sharing plans.
  3. The Diabetes Prevention Program Research Group Within-trial costeffectiveness
    of lifestyle intervention or metformin for the primary
    prevention of type 2 diabetes. Diabetes Care. 2003; 26(9):2518-2523.
    Objective: The Diabetes Prevention Program (DPP) demonstrated that intensive lifestyle
    and metformin interventions reduced the incidence of type 2 diabetes compared with a
    placebo intervention. The aim of this study was to assess the cost-effectiveness of the
    lifestyle and metformin interventions relative to the placebo intervention.
    Research Design and Methods: Analyses were performed from a health system
    perspective that considered direct medical costs only and a societal perspective that
    considered direct medical costs, direct nonmedical costs, and indirect costs. Analyses were
    performed with the interventions as implemented in the DPP and as they might be
    implemented in clinical practice.
    Results: The lifestyle and metformin interventions required more resources than the
    placebo intervention from a health system perspective, and over 3 years they cost
    approximately $2,250 more per participant. As implemented in the DPP and from a societal
    perspective, the lifestyle and metformin interventions cost $24,400 and $34,500,
    respectively, per case of diabetes delayed or prevented and $51,600 and $99,200 per
    quality-adjusted life year (QALY) gained. As the interventions might be implemented in
    routine clinical practice and from a societal perspective, the lifestyle and metformin
    interventions cost $13,200 and $14,300, respectively, per case of diabetes delayed or
    prevented and $27,100 and $35,000 per QALY gained. From a health system perspective,
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    Community Prevention Strategies in the Literature
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    costs per case of diabetes delayed or prevented and costs per QALY gained tended to be
    lower.
    Conclusions: Over 3 years, the lifestyle and metformin interventions were effective and
    were cost-effective from the perspective of a health system and society. Both interventions
    are likely to be affordable in routine clinical practice, especially if implemented in a group
    format and with generic medication pricing.
  4. Dueson RR, Brodovicz KG, Barker L, Zhou F, and Euler GL. Economic analysis
    of a child vaccination project among Asian Americans in Philadelphia, Pa.
    Arch Pediatr Adolesc Med. 2001 Aug; 155 (8):909-914.
    Objective: To ascertain the cost-effectiveness and the benefit-cost ratios of a communitybased
    hepatitis B vaccination catch-up project for Asian American children conducted in
    Philadelphia, Pennsylvania, from October 1, 1994, to February 11, 1996.
    Design: Program evaluation.
    Setting: South and southwest districts of Philadelphia.
    Participants: A total of 4384 Asian American children.
    Interventions: Staff in the community-based organizations educated parents about the
    hepatitis B vaccination, enrolled physicians in the Vaccines for Children program, and visited
    homes of children due for a vaccine dose. Staff in the Philadelphia Department of Public
    Health developed a computerized database; sent reminder letters for children due for a
    vaccine dose; and offered vaccinations in public clinics, health fairs, and homes.
    Main Outcome Measures: The numbers of children having received 1, 2, or 3 doses of
    vaccine before and after the interventions; costs incurred by the Philadelphia Department of
    Public Health and the community-based organizations for design, education, and outreach
    activities; the cost of the vaccination; cost-effectiveness ratios for intermediated outcomes
    (i.e., per child, per dose, per immunoequivalent patient, and per completed series);
    discounted cost per discounted year of life saved; and the benefit-cost ratio of the project.
    Results: For the completed series of three doses, coverage increased by 12 percentage
    points at a total cost of $268,600 for design, education, outreach, and vaccination. Costs
    per child, per dose, and per completed series were $64, $119, and $537, respectively. The
    discounted cost per discounted year of life saved was $11,525, and 106 years of life were
    saved through this intervention. The benefit-cost ratio was 4.44:1.
    Conclusion: Although the increase in coverage was modest, the intervention proved costeffective
    and cost-beneficial.
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  5. Finkelstein EA, Troped PJ, Will JC, and Palombo R. Cost-Effectiveness of a
    cardiovascular disease risk reduction program aimed at financially
    vulnerable women: The Massachusetts WISEWOMAN project. Journal of
    Women’s Health and Gender-Based Medicine. 2002; 11(6):519-526.
    Objective: The Massachusetts WISEWOMAN Project is a cardiovascular disease (CVD) risk
    reduction program targeting older uninsured and underinsured women. The costeffectiveness
    of providing CVD screening and enhanced lifestyle interventions (EI),
    compared with providing CVD screening and a minimum intervention (MI), was assessed at
    five EI and six MI health care sites.
    Methods: Cost calculations were based on data collected during screenings and
    intervention activities conducted with 1,586 women in 1996. Risk factor data, including
    cholesterol and blood pressure measures, were used to create a summary effectiveness
    outcome, the 10-year probability of developing coronary heart disease (CHD). The costeffectiveness
    ratio of the EI, compared with the MI, was calculated by dividing the
    incremental cost of the EI by the incremental effectiveness of the EI.