Background
Methods
Definitions
Selection of clinical preventive services for review
Clinical Preventive Service | Cohort / Timing | Frequency / Intensity | Estimated Coverage | Reference for BiW | |
---|---|---|---|---|---|
BC | BiW | ||||
Screening / treatment for depression | Ages 12-18 | Annually | Unknown | 7.4% | [16] |
Interventions to support breastfeeding | During pregnancy and after birth | Multiple sessions | Unknown | 46% | [17] |
Screening for obesity and referral to comprehensive, intensive behavioral intervention to promote improvement in weight status | Ages 6-17 | Screening – at all appropriate primary care visits | Unknown | 13% | [18] |
Intervention – attendance at > 70% of 10 2-h sessions | 7.2% | 7.2% | [19] | ||
Preventing tobacco use | Ages 6-17 | Annually | Unknown | 53% | [20] |
Application of fluoride varnish | On primary tooth at time of eruption (ages 1-5) | Every 6 months | Unknown | 62% | [21] |
Application of dental sealants | On permanent teeth at time of tooth eruption (ages 6-12) | 4 times (on 1st and 2nd bicuspids & molars) | Unknown | 59% | [22] |
Screening / treatment for breast cancer | Ages 50-74 | Every 2-3 years | 52% | 88% | [23] |
Screening / treatment for cervical cancer (cytology-based) | Ages 25-69 | Every 3 years | 69% | 88% | [24] |
Addition of HPV-based cervical cancer screening | Ages 30-65 | Every 5 years | 0% | 88% | [24] |
Screening / treatment for colorectal cancer | Ages 50-74 | FOBT every 2 years or sigmoidoscopy every 10 years | 50% | 76% | [25] |
Screening / treatment for lung cancer | Ages 55 - 74 with a 30 pack-year smoking history | Annually for 3 consecutive years | Unknown | 6%/60% | [26] |
Screening / treatment for hypertension | Ages 18 and older | At least once every 2 years | Unknown | 79% | [27] |
Screening / treatment for CVD | Ages 40-74 | Screening - once every 5 years | Unknown | 48% | [28] |
Treatment - ongoing | Unknown | 30% | |||
Screening / treatment for type 2 diabetes | Ages 18 and older – risk assessment | Every 3-5 years | Unknown | 58% | [31] |
High risk for T2DM – blood glucose | Every 3-5 years | Unknown | 80% | [32] | |
Very high risk for T2DM – blood glucose | Every year | Unknown | 80% | ||
Screening / treatment for depression | Non-pregnant adults ages 18 and older | At least once | Unknown | 12% | [33] |
Screening / treatment for depression | Pregnant and postpartum females | At least once per birth by 8 weeks postnatally | Unknown | 39% | [34] |
Screening / treatment for osteoporosis | Females age 65 | One-time | Unknown | 58% | [35] |
Screening / treatment for abdominal aortic aneurysm | Males age 65 who have ever smoked | One-time | Unknown | 86% | [36] |
Screening / treatment for HIV | Ages 15 – 65 | Low risk – once | 20% | 45% | [37] |
Increased risk – every 3-5 years | 20% | 63% | [38] | ||
Very high risk – every year | 20% | 83% | [39] | ||
During all pregnancies | 96% | 97% | |||
Screening / treatment for chlamydia and gonorrhea | Sexually active females 24 years of age or younger | When sexual history reveals new or persistent risk factors since the last negative test | Unknown | 55% | [40] |
Screening / treatment for HCV | Adults born between 1945 & 1965 | One-time | 33% | 48% | [41] |
Screening and BCI for the prevention of sexually transmitted infections | All sexually active adolescents and adults who are at increased risk for STIs | 30 min to ≥2 h of intensive behavioural counseling | Unknown | 29% | [42] |
Screening and BCI to prevent tobacco use | Ages 18 and older | Up to 90 min of total contact time, during multiple contacts | 19% | 51% | [43] |
Screening and BCI to prevent alcohol misuse | Ages 18 and older | Screening – annually during primary care visit | Unknown | 93% | [44] |
Screening – during pregnancy | Unknown | 97% | [45] | ||
Brief intervention – three 10 min sessions | Unknown | 41% | [46] | ||
Screening for and management of obesity | Ages 18 and older | Screening – ongoing | Unknown | 73% | [47] |
Management – at least one-time of 12-26 sessions in a year | Unknown | 33% | [48] | ||
Screening / treatment to prevent falls in the elderly | Community-dwelling elderly ages 65+ | Screening for risk - every year | Unknown | 18% | [49] |
Exercise - at least 150 min of moderate intensity / week | Unknown | Unknown | |||
Vitamin D suppl. - 800 IU / day for at least 12 months | Unknown | 61% | [50] | ||
Routine aspirin use for the prevention of CVD disease and CRC | Age 50-69 with a 10% or greater 10-year CVD risk & at low risk of bleeding | Screening for CVD risk - at age 50-59 | Unknown | 33% | [51] |
Screening for bleeding risk - at age 50-59 | Unknown | 33% | |||
Management - low-dose daily aspirin use for 10 years | Unknown | 24% | [52] | ||
Folic acid supplementation for the prevention of neural tube defects | Reproductive-age females | 0.4 to 0.8 mg (400 − 800 μg) of folic acid daily | Unknown | 34% | [50] |
Effectiveness of the intervention
Clinical Preventive Service | Effectiveness (Range) | Reference |
---|---|---|
Screening / treatment for depression (ages 12-18) | Cognitive behavioural therapy is associated with a clinically significant improvement in 12.1% of youth with MDD while fluoxetine is associated with a 25.7% (16.2 - 35.2%) improvement. | [57] |
Interventions to support breastfeeding | Breastfeeding promotion interventions are associated with a 44% (13 - 84%) increase in long-term (≥6 months) exclusive breastfeeding. | [58] |
Screening for obesity and referral to comprehensive, intensive behavioral intervention to promote improvement in weight status (children & youth) | Completion of a comprehensive intervention is associated with an 18.8% (6.1 – 40.2%) reduction in obesity. | |
Preventing tobacco use (school-aged children & youth) | Interventions aimed at reducing smoking initiation / smoking cessation among non-smoking / smoking children and youth have an effectiveness of 18% (6 - 28%) and 34% (5 - 69%). | [61] |
Application of fluoride varnish | The application of fluoride varnish reduces decayed, missing and filled teeth by 37% (24 - 51%). | [62] |
Application of dental sealants | The application of dental sealants reduces decayed, missing and filled teeth by 84% at year 1, decreasing to 55% at year 9. | [63] |
Screening / treatment for breast cancer | Screening mammography in women ages 50-74 leads to a reduction in breast cancer mortality of 21% (10 - 32%). | [64] |
Screening / treatment for cervical cancer (cytology-based) | Cervical cancer screening in women ages 25-69 leads to a reduction in cervical cancer mortality of 35% (10 - 53%). | [65] |
Addition of HPV-based cervical cancer screening | HPV-based screening is associated with a 55% (19 - 75%) reduction in the incidence of cervical cancers in females ages 30 – 64, when compared to cytology-based screening. | [66] |
Screening / treatment for colorectal cancer (CRC) | Screening with gFOBT is associated with a reduction in mortality from CRC by 18% (8 - 27%) and the incidence of late stage CRC by 8% (1 - 15%). Screening with flexible sigmoidoscopy is associated a reduction in mortality from CRC by 26% (18 - 33%) and the incidence of late stage CRC by 27% (18 - 34%). | [67] |
Screening / treatment for lung cancer | Screening for lung cancer is associated with a 19.6% (7.7 - 30.0%) reduction in mortality from lung cancer. | [68] |
Screening / treatment for hypertension | Lowering blood pressure by 10/5 mmHg results in a 22% (17 -27%) reduction in cardiovascular events and a 41% (33 - 48%) reduction in cerebrovascular events. | [69] |
Screening / treatment for cardiovascular disease | Statin therapy is associated with a 14% (7 - 20%) decreased risk of all-cause mortality, a 31% (12 - 46%) decreased risk of cardiovascular mortality, a 36% (29 - 43%) decreased risk of myocardial infarction and a 29% (18 - 38%) decreased risk of stroke. | [70] |
Screening / treatment for type 2 diabetes | Screening / treatment for type 2 diabetes is associated with 5.2 (2.7 - 7.5) myocardial infarction events prevented, 8.0 (6.2 - 9.5) microvascular events prevented and 3.2 (1.0 - 5.8) premature deaths prevented per 1000 people screened. | [71] |
Screening / treatment for depression (adults) | The use of ADM for major depression is associated with a 64% (12 - 85%) reduced risk of recurrent depression. | [72] |
Screening / treatment for depression (pregnant and postpartum females) | Participation in programs involving depression screening leads to a 32% (18 - 59%) reduced risk of depression 3-5 months later. | [73] |
Screening / treatment for osteoporosis | Long-term treatment compliance with bisphosphonates is associated with a 23% reduction in hip fractures and a 26% reduction in vertebral fractures. | |
Screening / treatment for abdominal aortic aneurysm (AAA) | Screening and treatment for AAA is associated with a 115% (89 - 144%) increase in elective surgeries, a 48% (34 - 60%) reduction in emergency surgeries and a 42% (12 - 61%) reduction in AAA-related mortality. | [76] |
Screening / treatment for HIV | The early initiation of antiretroviral therapy is associated with a 64% (25 - 96%) reduction in the transmission rate per person-year. | |
Screening / treatment for chlamydia and gonorrhea | Screening reduces the lifetime risk of chronic pelvic pain, infertility and ectopic pregnancy by 41%. | [79] |
Screening / treatment for HCV | The effectiveness of direct acting antiviral treatment in producing a sustained viral response (i.e., a cure) is 97% (95 - 99%). | |
Screening and BCI for the prevention of sexually transmitted infections | High intensity behavioural counselling interventions are associated with a 62% (40 - 76%) reduction in STI incidence in adolescents and a 30% (13 - 44%) reduction in STI incidence in adults. | [86] |
Screening and BCI to prevent tobacco use (adults) | Quit rates improve from 10.9 to 28.0% (23.0 - 33.6%). | |
Screening and BCI to prevent alcohol misuse (adults) | 13.9% (8.7 - 16.1%) improvement in the proportion of adults achieving recommended drinking limits. | [89] |
Screening for and management of obesity (adults) | 20% (14 to 25%) of participants lost at least 5% of their body weight. | [90] |
Screening / treatment to prevent falls in the elderly | Interventions involving exercise or physical therapy reduce falls in community-dwelling elderly by 13% (6 - 19%). | [91] |
Routine aspirin use for the prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) | Initiating low dose aspirin use for the primary prevention of CVD and CRC in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years reduces the risk of nonfatal myocardial infarction by 17% (6 – 26%), the risk of nonfatal stroke by 14% (2 – 24%), the incidence of colorectal cancer by 40% (24 – 53%) and the risk of death from CRC about 20 years later by 33% (14 – 48%). | |
Folic acid supplementation for the prevention of neural tube defects (NTDs) | Daily supplementation during pregnancy results in a 69% (42 - 83%) reduction in NTDs. | [94] |
Quality of life values used in the modelling
Health State (Definition or Duration) | QoL Reduction (Range) | Reference |
---|---|---|
Taking medication for prevention | 0.0024 (0.00 – 0.0033) | |
Alcohol Use | ||
Binge drinking | 0.123 (0.082 - 0.177) | |
Hazardous alcohol use (3 to 4.5 drinks per day for males and 1.5 to 3 drinks per day for females) | 0.179 (0.121 - 0.252) | |
Harmful alcohol use (> 4.5 drinks per day for males and > 3 drinks per day for females) | 0.304 (0.204 - 0.418) | |
Atopic dermatitis / eczema | 0.043 (0.026 – 0.065) | GBD |
Cancer – Breast | ||
False-positive mammography result (4.7 days) | 0.013 | [104] |
Diagnosis and treatment phase (3 months) | 0.288 (0.193 - 0.399) | GBD, [102] |
Metastatic phase (17.7 months) | 0.451 (0.307 - 0.600) | |
Remission | 0.049 (0.031 - 0.072) | |
Cancer – Cervical | ||
False-positive Pap smear (10 months) | 0.046 | GBD |
Diagnosis and treatment for CIN (20 months) | 0.066 | |
Diagnosis and treatment phase for cancer (4.8 months) | 0.288 (0.193 - 0.399) | GBD, [105] |
Metastatic phase (9.2 months) | 0.451 (0.307 - 0.600) | |
Remission | 0.049 (0.031 - 0.072) | |
Cancer – Colorectal | ||
Diagnosis and treatment phase (4 months) | 0.288 (0.193 - 0.399) | GBD |
Metastatic phase (9.7 months) | 0.451 (0.307 - 0.600) | |
Remission | 0.049 (0.031 - 0.072) | |
Cancer – Liver | ||
Diagnosis and treatment phase (4 months) | 0.288 (0.193 - 0.399) | GBD |
Metastatic phase (2.5 months) | 0.451 (0.307 - 0.600) | |
Remission | 0.049 (0.031 - 0.072) | |
Cancer – Lung | ||
Diagnosis and treatment phase (3.3 months) | 0.288 (0.193 - 0.399) | GBD |
Metastatic phase (4.5 months) | 0.451 (0.307 - 0.600) | |
Remission | 0.049 (0.031 - 0.072) | |
Cancer – Ovarian | ||
Diagnosis and treatment phase (3.2 months) | 0.288 (0.193 - 0.399) | GBD |
Metastatic phase (25.6 months) | 0.451 (0.307 - 0.600) | |
Remission | 0.049 (0.031 - 0.072) | |
Cardiovascular Disease - myocardial infarction (1 month) | 0.100 (0.065 – 0.137) | GBD |
Cardiovascular Disease - stroke | 0.200 (0.134 - 0.265) | GBD, [106] |
Childhood asthma | 0.040 (0.024 – 0.060) | GBD, [107] |
Chronic pelvic pain (5 years) | 0.114 (0.078 - 0.159) | GBD, [79] |
Dental caries | ||
Symptomatic dental caries | 0.010 (0.005 - 0.019) | GBD |
Severe tooth loss | 0.067 (0.045 - 0.095) | |
Depression | ||
Mild | 0.145 (0.099 - 0.209) | [108] |
Moderate | 0.396 (0.267 - 0.531) | |
Severe | 0.658 (0.477 - 0.807) | |
Diabetes – Type 2 | ||
Uncomplicated | 0.049 (0.031 - 0.072) | GBD |
Diabetic neuropathy | 0.133 (0.089 - 0.187) | |
Ectopic pregnancy (4 weeks) | 0.114 (0.078 - 0.159) | GBD, [79] |
End-stage renal disease | ||
Chronic kidney disease | 0.104 (0.070 - 0.147) | GBD |
On dialysis | 0.571 (0.398 - 0.725) | |
Fetal alcohol spectrum disorder | 0.50 (0.44 - 0.57) | [109] |
Fetal alcohol syndrome | 0.56 (0.48 - 0.63) | |
Gastrointestinal bleeding (28 days) | 0.265 | [110] |
Hepatitis C infection | ||
Non-cirrhosis (fibrosis stage 0-3) | 0.088 (0.038 – 0.138) | |
Compensated cirrhosis (fibrosis stage 4) | 0.138 (0.088 – 0.188) | |
Decompensated cirrhosis | 0.188 | |
Liver transplant (1st year) | 0.438 | |
Liver transplant (subsequent years) | 0.163 | |
On-treatment | 0.113 (0.063 – 0.163) | |
HIV/AIDS | ||
Symptomatic HIV without anemia | 0.274 (0.184 - 0.377) | GBD |
Symptomatic HIV with mild anemia | 0.277 (0.189 - 0.379) | |
Symptomatic HIV with moderate anemia | 0.312 (0.217 - 0.418) | |
Symptomatic HIV with severe anemia | 0.381 (0.269 - 0.505) | |
AIDS with antiretroviral treatment (ART) without anemia | 0.078 (0.052 - 0.111) | |
AIDS with ART with mild anemia | 0.081 (0.054 - 0.116) | |
AIDS with ART with moderate anemia | 0.125 (0.085 - 0.176) | |
AIDS with ART with severe anemia | 0.215 (0.148 - 0.295) | |
Infertility | ||
Primary infertility | 0.008 (0.003 - 0.015) | GBD |
Secondary infertility | 0.005 (0.002 - 0.011) | |
Intellectual disability | ||
Borderline | 0.011 (0.005 - 0.020) | GBD |
Mild | 0.043 (0.026 - 0.064) | |
Moderate | 0.100 (0.066 - 0.142) | |
Profound | 0.200 (0.133 - 0.283) | |
Obesity | ||
Children / youth | 0.026 (0.017 – 0.036) | |
Adults | 0.037 (0.024 – 0.049) | [115] |
Osteoporosis | ||
Hip fracture (6 months) | 0.355 | [116] |
Vertebral fracture (12 months) | 0.050 | [117] |
Chlamydial or gonococcal infection – mild | 0.006 (0.002 - 0.012) | GBD |
Spina bifida | ||
Sacral lesion | 0.34 (0.06 – 0.62) | [118] |
Lower lumbar lesion | 0.42 (0.22 – 0.62) | |
Upper lumbar lesion | 0.52 (0.25 – 0.78) | |
Tobacco smoking | ||
Light (< 10 cigarettes / day) | 0.031 (0.018 - 0.045) | [115] |
Moderate (10-19 cigarettes / day) | 0.033 (0.019 - 0.047) | |
Heavy (≥20 cigarettes / day) | 0.062 (0.042 - 0.082) | |
Vision deficits | ||
Mild | 0.003 (0.001 - 0.007) | GBD |
Moderate | 0.031 (0.019 - 0.049) | |
Severe | 0.184 (0.125 - 0.258) | |
Blindness | 0.187 (0.124 - 0.260) |
Resource unit costs used in the modelling
In 2017 Canadian Dollars | ||
---|---|---|
Health State / Resource Unit | Unit Cost | Reference |
Patient time costs | $29.69 / hour | [121] |
Office visit to a General Practitioner | $34.85 | [127] |
GP follow-up phone call or email correspondence | $15.00 | |
Abdominal aortic aneurysm | ||
Emergency repair surgery | $46,853 | |
Elective open surgery | $45,998 | |
Elective endovascular aneurysm repair surgery | $36,039 | |
Alcohol Use | ||
Low | $91(F) $195(M) / year | |
Hazardous (3 to 4.5 drinks per day for males and 1.5 to 3 drinks per day for females) | $708(F) $1238(M) / year | |
Harmful (> 4.5 drinks per day for males and > 3 drinks per day for females) | $2925(F) $3133(M) / year | |
Fetal alcohol spectrum disorder lifetime cost | $1,118,811 | [135] |
Fetal alcohol syndrome lifetime cost | $1,664,074 | |
Atopic dermatitis / eczema lifetime costs | $3420 | [136] |
Cancer – breast | ||
Mammogram | $79 | [137] |
Biopsy | $386 | [104] |
Radiotherapy | $5233 | [138] |
Breast conserving surgery | $5152 | |
Mastectomy | $7260 | |
Acute care phase of fatal cancer | $47,230 | |
First year costs for survivors | $22,695 | |
Ongoing annual costs for survivors | $1753 | [141] |
Cancer – cervical | ||
Conventional cytology screen | $70 | |
HPV test | $96 | [145] |
Colposcopy with biopsy | $251 | |
Treatment for a precancerous lesion | $1216 | |
Acute care phase of fatal cancer | $46,603 | [139] |
First year costs for survivors | $20,258 | |
Ongoing annual costs for survivors | $821 | [146] |
Cancer – colorectal | ||
FIT test | $14.74 | BC Medical Services Plan (MSP) |
Colonoscopy | $667 | BC MSP |
Acute care phase of fatal cancer | $49,197 | [139] |
First year costs for survivors | $40,080 | |
Ongoing annual costs for survivors | $3687 | [147] |
Cancer – liver | ||
Acute care phase of fatal cancer | $30,922 | [139] |
First year costs for survivors | $36,708 | |
Ongoing annual costs for survivors | $6287 | [147] |
Cancer – lung | ||
LDCT screening exam | $198 | [148] |
Follow-up chest radiograph | $67 | |
Follow-up chest CT | $164 | |
Follow-up PET/CT scan | $1399 | |
Percutaneous biopsy – CT-guided | $1083 | |
US-guided | $682 | |
Bronchoscopy without biopsy | $747 | |
Bronchoscopy with biopsy | $804 | |
Mediastinoscopy | $976 | |
Thoracoscopy | $16,814 | |
Thoracotomy | $18,689 | |
Acute care phase of fatal cancer | $37,046 | [139] |
First year costs for survivors | $33,523 | |
Ongoing annual costs for survivors | $7575 | [147] |
Cancer – ovarian | ||
Acute care phase of fatal cancer | $51,914 | [139] |
First year costs for survivors | $33,256 | |
Ongoing annual costs for survivors | $7889 | [147] |
Cardiovascular disease | ||
Full lipid profile | $21.31 | [149] |
Annual cost of statin medication | $135 | [150] |
Cardiovascular Disease - myocardial infarction | ||
Acute care phase of a fatal MI | $15,536 | [151] |
First year costs for survivors | $33,934 | [152] |
Ongoing annual costs for survivors | $2278 | |
Cardiovascular Disease – stroke | ||
First year costs for survivor | $21,139 | |
Ongoing annual costs for survivors | $6246 | |
Childhood asthma | ||
Lifetime per case | $5230 | [154] |
Childhood leukemia | ||
Lifetime per case | $134,920 | [155] |
Dental caries | ||
Topical fluoride application | $10.61 | [156] |
Pit and fissure sealant application (1st/subsequent per quadrant) | $19.74 / $10.83 | |
Amalgam restoration | $93 | |
Day surgery for dental cavities | $1884 | [157] |
Depression | ||
Antidepressant medication (ADM) / year (adults) | $438 | [158] |
ADM / year (adolescents) | $368 | [159] |
Group therapy (CBT session for 12 adolescents) | $241 | [160] |
Group therapy (CBT session for 8 pregnant females) | $269 | |
Annual health care costs attributable to depression (adolescents) | $5251 | |
Suicide attempt | $9056 | |
Completed suicide | $8233 | |
Diabetes – Type 1 lifetime cost | $76,598 | [155] |
Diabetes – Type 2 | ||
Cost per A1C test | $6.09 | [164] |
Blindness (annual cost) | $2330 | [165] |
Lower extremity amputation (surgery/annual cost) | $33,642 / $1396 | [166] |
End-stage renal disease annual cost | $86,278 | |
Gastrointestinal bleeding (per hospitalization) | $6425 | [167] |
Gastrointestinal / lower respiratory tract infection (per infection) | $462 | [168] |
Hepatitis C infection | ||
Incremental annual health care cost | ||
HCV infection (non-cirrhosis stages f0 to f3) | $400 | |
Compensated cirrhosis (stage f4) | $843 | |
Decompensated cirrhosis | $15,284 | |
Cost of direct-acting antivirals | $13,500 | |
Complete blood count | $10.96 | BC MSP |
Thyroid stimulating hormone | $9.90 | BC MSP |
Renal panel | $31.52 | BC MSP |
Liver transplant (first year / annual) | $162,901 / $9654 | [174] |
HIV / AIDS | ||
Annual cost of ART | $9490 | [158] |
Annual direct medical costs (excluding medications) | ||
Asymptomatic HIV | $1889 | [175] |
Symptomatic HIV | $2843 | |
AIDS | $10,900 | |
Hypertension | ||
Annual cost of antihypertensive medication | $193 | [158] |
Intellectual disability lifetime costs | $270,345 | [176] |
Lower extremity amputation (surgery / ongoing annual) | $33,642 / $1396 | [166] |
Neural tube defects | ||
Folic acid supplementation (annual costs) | $15.70 | [177] |
Spina bifida (lifetime costs) | $801,991 | [120] |
Anencephaly live birth | $4399 | |
Obesity | ||
Excess annual medical care costs | $698 (M) / $953 (F) | [133] |
Structured behavioural intervention (per child/youth) | $7681 | [180] |
Structured behavioral intervention (per adult) | $607 | |
Osteoporosis | ||
Bone density scan | $111 | [184] |
Annual cost of medication | $188 | [159] |
Hip fracture annual costs | $62,152 | [185] |
Vertebral fracture annual costs | $25,965 | |
Otitis media per case | $251 | [186] |
Sexually transmitted infections | ||
Group behavioural counselling intervention (session for 5 individuals) | $487 | Calculated |
Direct medical costs per infection | ||
Chlamydia | $229 | [187] |
Gonorrhea | $169 | |
Hepatitis B virus | $2536 | |
HIV | $289,543 | |
Human papilloma virus | $112 | |
Herpes simplex virus type 2 | $632 | |
Syphilis | $674 | |
Tobacco smoking | ||
Light (< 10 cigarettes / day) | $785 / year | [133] |
Moderate (10-19 cigarettes / day) | $1386 / year | |
Heavy (≥20 cigarettes / day) | $2050 / year | |
Smoking cessation aids per quit attempt | $272 | [188] |
Sensitivity analysis
Clinical Preventive Services | CEa (1.5% Discount Rate) | Key Variable(s) | Base Value | Range | |||
---|---|---|---|---|---|---|---|
Base | Range | ||||||
Screening for Asymptomatic Disease or Risk Factors - Youth | |||||||
Screening for depression | $28,215 | $21,555 | $45,994 | Reduction in quality of life due to depression | 31% | 15% | 45% |
Behavioural Counseling Interventions - Children/Youth | |||||||
Interventions to support breastfeeding | ($9021) | ($14,757) | $19,699 | % of women attending interventions who exclusively breastfeed at 6 months | 44% | 13% | 84% |
Growth monitoring and healthy weight management in children and youth | $29,436 | $10,148 | $524,527 | Length of time that avoided costs accrue | Lifetime | 10 Years | |
Preventing tobacco use (school-aged children & youth) | ($7349) | ($10,083) | $23,905 | % of smokers who cease as a result of intervention(s) | 34% | 5% | 69% |
Preventive Medication / Devices - Children | |||||||
Fluoride varnish | $43,038 | $16,391 | $86,076 | Change in quality of life due to improved oral health | 0.01 | 0.005 | |
Frequency of fluoride varnish application | Every 6 months | Annually | |||||
Dental sealants | ($24,690) | ($32,248) | ($17,132) | Cost of dental fillings | $92.75 | $83.10 | $102.40 |
Screening for Asymptomatic Disease or Risk Factors - Adults | |||||||
Screening for breast cancer | $19,720 | $11,659 | $45,514 | % reduction in breast cancer deaths as a result of mammogram screening | 21% | 10% | 32% |
Screening (cytology-based) for cervical cancer | $25,542 | $13,818 | $99,328 | Effectiveness of screening in reducing cervical cancer deaths / incidence | 35% / 44% | 10% / 25% | 53% / 58% |
Addition of HPV-based cervical cancer screening | ($21,556) | ($16,414) | ($23,377) | % improvement in HPV-screening effectiveness vs. cytology-based screening | 55% | 19% | 75% |
Screening for colorectal cancer | $47,265 | $32,923 | $82,979 | Effectiveness of screening in preventing colorectal cancer deaths | gFOBT - 18% | 8% | 27% |
Colonoscopy - 26% | 18% | 33% | |||||
Screening for lung cancer | $2240 | $1228 | $9206 | % of lung cancer deaths avoided with screening | 19.6% | 7.7% | 30.0% |
Screening for hypertension | $15,254 | $9314 | $24,485 | Effectiveness of drug treatment in reducing cardiovascular and cerebrovascular events | Cardio - 22% | 17% | 29% |
Cerebro - 41% | 33% | 48% | |||||
Screening for cardiovascular disease risk and treatment (with statins) | $3223 | $1458 | $7849 | Effectiveness of drug treatment in reducing all-cause mortality, myocardial infarction and stroke | Mortality - 14% | 7% | 20% |
MI - 36% | 29% | 43% | |||||
Stroke - 29% | 18% | 38% | |||||
Screening for type 2 diabetes mellitus (T2DM) | ($3121) | ($6348) | $1121 | Proportion of office visit for screening | 50% | 33% | |
Screening for depression in general adult population | Dominated | ||||||
Screening for depression in pregnant and postpartum women | $23,042 | $11,149 | $43,255 | % reduction in depression risk due to screening | 32% | 18% | 59% |
Screening for osteoporosis | ($29,412) | ($43,257) | $38,997 | Change in the effectiveness of screening / treatment | |||
Hip fracture reduction rate | 23% | 8% | $36 | ||||
Vertebral fracture reduction rate | 26% | 12% | $38 | ||||
Screening for abdominal aortic aneurysm (AAA) | $11,995 | $9328 | $38,251 | Change in the relative risk of AAA-related mortality | 0.58 | 0.39 | 0.88 |
Screening for Sexually Transmitted Infections and Blood Borne Pathogens - Adults | |||||||
Screening for human immunodeficiency virus | $16,434 | ($12,463) | $80,739 | % reduction in HIV transmission rate with early antiretroviral therapy | 64% | 25% | 96% |
Screening for chlamydia and gonorrhea | $57,174 | $37,189 | $234,414 | Effectiveness of screening in reducing pelvic pain, infertility and ectopic pregnancy | 41% | 10% | |
Screening for hepatitis C virus | $3427 | $2570 | $5141 | Probability of cirrhosis in Hepatitis C Virus positive individuals | 15% | 10% | 20% |
Behavioural Counseling Interventions - Adults | |||||||
Prevention of sexually transmitted infections (STIs) | $10,267 | $6921 | $22,513 | Effectiveness of high intensity behavioural counselling interventions in reducing the incidence of STIs in adolescents and adults | Adolescents - 62% | 40% | 74% |
Adults - 30% | 13% | 44% | |||||
Counselling and interventions to prevent tobacco use | ($1863) | ($3441) | $779 | Quit rate for smoking as a result of intervention | 28.0% | 23.0% | 33.6% |
Screening and behavioural counseling interventions to reduce unhealthy alcohol use | $9609 | ($375) | $23,676 | Frequency of screening | Annual | Every 5 yrs | |
Effectiveness of counselling in changing behaviour | 13.9% | 8.7% | |||||
Screening for and management of obesity | $12,160 | $5682 | $28,565 | Frequency of measuring of height / weight, physical activity and diet advice | Every 2 yrs | Annual | Every 3 yrs |
Preventing falls | $35,213 | $13,950 | $77,738 | Cost of exercise per hour | $5.00 | $0.00 | $15.00 |
Preventive Medication / Devices - Adults | |||||||
Routine aspirin use for the prevention of cardiovascular disease (CVD) and colorectal cancer | $2302 | -$1189 | $24,255 | Effectivenes of aspirin in reducing risk of cardiovascular disease, cerebrovascular disease, and colorectal cancer incidence and death | Cardio - 17% | 6% | 26% |
Cerebro - 14% | 2% | 24% | |||||
CRC Incidence - 40% | 24% | 53% | |||||
CRC Mortality - 33% | 14% | 48% | |||||
Folic acid supplementation for the prevention of neural tube defects | $195,379 | $88,410 | $431,770 | Frequency of advice on folic acid supplementation | Annual | Every 3 yrs |
Results
Clinical Preventive Services | CPBb (0% Discount) | CEc (% Discount) | |||
---|---|---|---|---|---|
B.C. | ‘BiW’a | Gap | 1.5% | 0% | |
Screening for Asymptomatic Disease or Risk Factors - Youth | |||||
Screening for depression | Unknown | 222 | $28,215 | $27,331 | |
Behavioural Counseling Interventions - Children/Youth | |||||
Interventions to support breastfeeding | Unknown | 5002 | ($9021) | ($11,966) | |
Growth monitoring and healthy weight management in children and youth | 196 | 196 | 0 | $29,436 | $18,148 |
Preventing tobacco use (school-aged children & youth) | Unknown | 4123 | ($7349) | ($9538) | |
Preventive Medication / Devices - Children | |||||
Fluoride varnish | Unknown | 150 | $43,038 | $43,038 | |
Dental sealants | Unknown | 157 | ($24,690) | ($29,320) | |
Screening for Asymptomatic Disease or Risk Factors – Adults | |||||
Screening for breast cancer | 703 | 1189 | 486 | $19,720 | $18,326 |
Screening (cytology-based) for cervical cancer | 1153 | 1471 | 318 | $25,542 | $26,980 |
Addition of HPV-based cervical cancer screening | 0 | 655 | 655 | ($21,556) | ($19,264) |
Screening for colorectal cancer | 1141 | 1734 | 593 | $47,265 | $44,213 |
Screening for lung cancer | Unknown | 1745 | $2240 | $2080 | |
Screening for hypertension | Unknown | 11,587 | $15,254 | $10,760 | |
Screening for cardiovascular disease risk and treatment (with statins) | Unknown | 9370 | $3223 | $1392 | |
Screening for type 2 diabetes mellitus (T2DM) | Unknown | 3494 | ($3121) | ($3453) | |
Screening for depression in general adult population | Unknown | -8 | Dominated | ||
Screening for depression in pregnant and postpartum women | Unknown | 109 | $23,042 | $10,140 | |
Screening for osteoporosis | Unknown | 91 | ($29,412) | ($34,145) | |
Screening for abdominal aortic aneurysm | Unknown | 340 | $11,995 | $9973 | |
Screening for Sexually Transmitted Infections and Blood Borne Pathogens - Adults | |||||
Screening for human immunodeficiency virus | Unknown | 360 | $16,434 | $16,434 | |
Screening for chlamydia and gonorrhea | Unknown | 143 | $57,174 | $53,410 | |
Screening for hepatitis C virus | 2695 | 3920 | 1225 | $3427 | $2810 |
Behavioural Counseling Interventions - Adults | |||||
Prevention of sexually transmitted infections (STIs) | Unknown | 3285 | $10,267 | $10,267 | |
Counselling and interventions to prevent tobacco use | 3730 | 5944 | 2214 | ($1863) | ($3344) |
Screening and behavioural counseling interventions to reduce unhealthy alcohol use | Unknown | 5035 | $9609 | $9258 | |
Screening for and management of obesity | Unknown | 2287 | $12,160 | $11,140 | |
Preventing falls | Unknown | 429 | $35,213 | $35,213 | |
Preventive Medication / Devices – Adults | |||||
Routine aspirin use for the prevention of cardiovascular disease (CVD) and colorectal cancer | Unknown | 1098 | $2302 | $411 | |
Folic acid supplementation for the prevention of neural tube defects | Unknown | 95 | $195,379 | $113,155 |