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There is broad debate over whether preventive health services save money or represent a good investment. This paper analyzes the estimated cost of adopting a package of twenty proven preventive services-including tobacco cessation screening, alcohol abuse screening, and daily aspirin use-against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million lifeyears annually. What's more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending. These findings suggest that policy makers should pursue options that move the nation toward greater use of proven preventive services.

PURPOSEThe Patient Protection and Affordable Care Act's provisions for firstdollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services. METHODSWe assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures-cost-effectiveness and clinically preventable burden-for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. RESULTSThe 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesityrelated behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations.CONCLUSIONS This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives. 2017;15:14-22. https://doi.org/10.1370/afm.2017. Ann Fam Med INTRODUCTIONT he landscape for prevention in primary care has changed dramatically since the Committee on Clinical Preventive Service Priorities published the first ranking of clinical preventive services in 2001, 1 and the National Commission on Prevention Priorities (NCPP) last updated the list in 2006. 2 A growing evidence base has expanded knowledge about effective preventive services. At the same time, the Patient Protection and Affordable Care Act (ACA) and the pursuit of the Triple Aim 3 seek to expand access to and the efficiency of primary care.Changes in primary care have potential to improve utilization of preventive services. Patient-centered medical homes (PCMHs) have been associated with increased use of preventive services, though it is not clear whether health and financial outcomes are affected. [4][5][6] Accountable Care Organizations (ACOs), when combined with PCMHs, may empower primary care and incentivize change, 7 and ACO shared-savings contracts may encourage hospital systems and specialty providers to become vested stakeholders in evidence-based prevention. Preventive care quality measures and incentives in ACO contracts might ass...

Screening for KRAS and BFAF mutation improves the cost-effectiveness of anti-EGFR therapy, but the incremental cost effectiveness ratio remains above the generally accepted threshold for acceptable cost effectiveness ratio of $100 000/quality adjusted life year.

Agency for Healthcare Research and Quality.