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A new study released today by Partnership for Prevention identifies the most beneficial and cost-effective preventive health services, giving Americans a unique tool to make decisions about their health care.  The report, “Priorities for America’s Health: Capitalizing on Life-Saving, Cost-Effective Preventive Services,” sheds light on the startling fact that more than 50 percent of Americans who need these valuable preventive services continue to go without them.

According to “Priorities for America’s Health”, the three most valuable preventive health services that can be offered in medical practice today, each of which save more money than they cost and provide enormous health benefits are: 

• Discussing daily aspirin use with at-risk adults to prevent cardiovascular disease

• Immunizing children

• Intervening with smokers to help them quit

The study, sponsored by the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ), part of the Department of Health and Human Services (HHS), looked at all the preventive services currently offered by doctors and developed a ranking of 25 recommended services based on those that provide the greatest health benefits, both in terms of saving lives and improving quality of life, while offering the most value for the health care dollars.  The report will be published in the American Journal of Preventive Medicine in July, and is available on its Web site today.

 “Currently, about 95 percent of health care dollars in the United States are spent on treating diseases, with relatively little attention paid to preventing diseases, which should be a national priority,” said David Satcher, M.D., Ph.D., former U.S. Surgeon General and chair of the National Commission on Prevention Priorities (NCPP), a blue-ribbon panel that was convened by Partnership for Prevention to help guide the report.  “This landmark study highlights the importance of shifting focus to preventive care, which can provide an enormous positive impact on health and well-being, while also more effectively allocating our precious health care dollars.  Basically, these are the preventive health services that offer the biggest bang for the buck.” 

The ranking of preventive services is attached.

Many Valuable Services Underutilized by Americans

“Not all preventive services you can get from your doctor are the same; some prevent more disease than others while some provide more value for the dollar.  According to our study, many Americans are not receiving the most valuable preventive services,” said Ashley Coffield, MPA, senior analyst with Partnership for Prevention and co-author of the study.  “Priorities for America’s Health’ points out which services we should focus on to have the biggest impact on our nation’s health.” 

According to the study, five of the highest ranking services are being utilized by less than half of the people who need them.  These are: 1.) discussing daily aspirin use with at-risk adults; 2.) screening adults age 50+ for colorectal cancer; 3.) intervening with smokers to help them quit; 4.) vaccinating older adults against bacterial pneumonia; and 5.)  screening young, sexually active women for Chlamydia.

Coffield continued, “If these services were more consistently offered to the American people, fewer people would die and fewer people would suffer from diseases that are preventable.  The U.S. could also get more for the dollars it invests in health care by focusing on the services that provide the most benefits at the least cost, while also making progress toward reducing disparities in health outcomes.”

Partnership for Prevention worked in collaboration with HealthPartners Research Foundation, a Minneapolis-based clinical and health services research organization.  The research team analyzed scientific evidence – including more than 8,000 published studies– and summarized the best available data on clinical preventive services to assist all types of decision makers in choosing where to focus their prevention efforts.

"We've always known that these preventive services were beneficial, but until now we didn't appreciate the order of magnitude by which their potential effectiveness differs,” said Steven H. Woolf, M.D., professor and director of research in VCU’s Department of Family Medicine and a member of the National Academy of Sciences’ Institute of Medicine. Woolf was a member of the research team. “This report allows physicians, patients, and policymakers to give priority to the preventive services that will do the most good."

“The rankings will help clinicians, health plans, employers, policy makers and the public prioritize the clinical preventive services that provide the greatest health impact and the most value.  This is a road map to better health and a higher return on our investments in health care,” said Julie Gerberding, M.D., Ph.D., director of the U.S. Centers for Disease Control.

The study examined 21 preventive services recommended for asymptomatic people and for those at high-risk for coronary heart disease by the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts sponsored by the AHRQ.  The study also included four recommendations of the Advisory Committee on Immunization Practices (ACIP): three for adults and one for a defined series of childhood immunizations.  The USPSTF and ACIP recommendations are considered the gold standard among recommendations for preventive care.  However, decision-makers wishing to improve delivery of preventive services face competing demands for finite resources and need additional information about which services provide the most benefits to the populations they serve.

“This study not only helps patients and clinicians develop a preventive health plan, it further validates the important work of the U.S. Preventive Services Task Force,” said Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality.

Key Findings, High-Ranking Services with Low Utilization Rates:

• Doctors discussing taking a daily aspirin with men over 40, women over 50 and others at risk is one of the most valuable preventive services that can be offered in medical practice today.  Daily aspirin use can prevent heart attacks and stroke.  If all people in these age groups were advised to use aspirin daily, more than 80,000 lives could be saved annually.  Aspirin is cheap and easy to get but taking it daily is not for everyone.  Adults should talk to their doctors before getting started on a daily aspirin regimen.
   
• Screening patients to determine if they smoke or use other tobacco products, providing brief smoking cessation counseling, and offering patients therapies and referrals to help them quit.  This service is one of the three most important and cost-effective preventive services that can be offered in medical practice, yet 65 percent of adults have not received this service as it is recommended.  In truth, this service is cost saving:  if it was offered to all smokers, taking into account reasonable success rates, it could save $3 billion in medical costs annually.
   

• The pneumococcal immunization for older adults. Pneumococcal disease is a bacterial form of pneumonia that can lead to hospitalization and death.  One dose of the pneumococcal immunization is effective for at least 10 years, yet 45 percent of all adults over the age of 65 have not received it.  Disparities in delivery of this vaccine are particularly stark: 78 percent of Hispanic adults and 63 percent of black adults over age 65 reported never having received the pneumococcal immunization compared to 38 percent of white adults over age 65.  This vaccine could save $50 million annually in medical care costs if all people over age 65 were offered it.
   
• Regular screening for colorectal cancer. Although colorectal cancer is the second deadliest cancer, it is highly curable when found early.  Yet 65 percent of the target population is not up to date on screening.  If all adults over the age of 50 were routinely screened for colorectal cancer, 19,000 deaths could be prevented annually.
   
• Screening for Chlamydia among sexually active women.  Chlamydia is the most common bacterial STD (sexually transmitted disease) in the U.S. with an estimated 3 million new cases annually.  If all women under 25 were screened periodically, 60,000 cases of pelvic inflammatory disease, 8,000 cases of chronic pelvic pain and 7,500 cases of infertility would be prevented annually.  While Chlamydia screening is recommended for all sexually active women under the age of 25, only 40 percent of women in this age group have received this screening service.  This service is highly cost-effective at preventing the unnecessary heartache and expense of lifelong infertility.

Ranking Methodology

Partnership ranked services based on two criteria. The first was the disease, injury and premature death prevented if the service were delivered to all people who would benefit from it. 

The second was cost effectiveness, measured as the net cost of the preventive service divided by the service’s health benefits.  Net costs are the resources used in providing the service less the resources saved by avoiding disease or injury (e.g., avoided hospital costs).  Cost effectiveness provided a standard measure for comparing services’ return on investment.

Scores for the two criteria were added, and the services were ranked in descending order.  (The only services receiving the highest possible score on both criteria were discussing daily aspirin use with men over 40 and women over 50; childhood vaccines and smoking cessation counseling.)  Finally, the authors identified which of the highest ranked preventive services had the lowest delivery rates nationally as well as which preventive services would provide the most gains in health were utilization rates improved above current levels.