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26 August 2012

The Cost-Effectiveness of Environmental Approaches to Disease Prevention

Fellow Ellen Silbergeld would like to share the following article with the Collegium Ramazzini. The Cost-Effectiveness of Environmental Approaches to Disease Prevention. N Engl J Med 2012; 367:295-297 July 26, 2012

How can society prevent the most disease and deaths per dollar spent? This question arose throughout the debate on U.S. health care reform and will continue to drive decision making as health care funding becomes increasingly constrained. In an atmosphere of austerity, demonstrating the cost-effectiveness of preventive health interventions becomes particularly important.

Although preventive approaches to disease are intuitively appealing - and frequently presented as a way to reduce costs - analyses have suggested that, as a whole, they're no more cost-effective than therapeutic interventions. But are some preventive approaches more cost-effective than others?

The National Commission on Prevention Priorities attempted to address this question, ranking clinical preventive services in terms of cost-effectiveness and "clinically preventable burden" of disease. Yet some preventive services, such as tobacco taxes or water fluoridation, are not delivered in health care settings. Understanding whether certain approaches are more cost-effective than others requires a framework for categorizing preventive interventions.

Medicine traditionally classifies preventive interventions on the basis of disease course: primary prevention aims to prevent new cases of disease; secondary prevention and tertiary prevention mitigate the effects of existing disease. We propose two overlapping dimensions to further characterize primary preventive interventions: environmental versus person-directed, indicating whether the proximate target is an element of the environment or an individual, and clinical versus nonclinical, indicating where an intervention takes place...



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