1 / 19

Evaluating Preventable Mortality: Impact of Behavioral Interventions on Health Outcomes

This document assesses potential outcomes of behavioral health interventions, focusing on the reduction of mortality rates and quality-adjusted life years (QALYs). It discusses the relative effectiveness of treatments for heart disease versus lifestyle changes like smoking cessation and exercise. Key references highlight the importance of comparing interventions systematically for policy-making and personal decision-making. The calculations for predicting preventable deaths and cost-effectiveness are outlined, emphasizing the crucial role of adherence and the impact of preventive services on the overall clinical burden.

lizina
Télécharger la présentation

Evaluating Preventable Mortality: Impact of Behavioral Interventions on Health Outcomes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. BCC TransbehavioralOutcome Assessments December 06, 2001

  2. Potential Outcomes • Criterion • % of individuals who attain behavior goal • Reduction in 30 mortality Woolf, 1999 • Clinical Preventable Burden & Cost Effectiveness Coffield et al., 2001 • Quality adjusted life years saved (QALYs) • Net cost of service/QALYs

  3. References • Woolf, S.H. (1999). The need for perspective in evidence-based medicine. JAMA, 282, 2358-2365. • Coffield, Maciosek, McGinnis et al. (2001). Priorities among recommended clinical preventive services. American Journal of Preventive Medicine, 21(1), 1-9.

  4. Which Interventions Work Best? • Woolf recommends systematically comparing the relative effectiveness of interventions in preventing disease outcomes • Treatment of heart disease reduces mortality by 21-33% • Are these treatments more or less likely to prevent death than smoking cessation or exercise?

  5. Policy and Personal Implications • For Policy Makers: Comparisons are important in terms of reducing number of deaths in the population. • For Individuals: Comparisons inform personal choices.

  6. Projected Outcomes

  7. Projected Outcomes

  8. Projected Outcomes

  9. Calculations • Population projections were derived by multiplying the number of deaths potentially preventable by the intervention by the preventable fraction • Preventable fraction=(p[1-RRR])/(RRR+p[1-RRR]) • p=proportion of eligible population that has not received the intervention • RRR=relative risk reduction

  10. Calculations • Reduction of 30 year mortality • Absolute difference between 30 year cumulative probability of death with and without the intervention • Cumulative probability of death was derived from a standard survival calculation for hypothetical cohort of 45-year-old women using annual mortality rates specified in the tables • Cumulative death rates x RRR = 30 year probability of death with the intervention

  11. Comments • Lifestyle changes offer much greater benefits when compared to disease treatments • Offers rough approximation of benefits comparing tobacco cessation versus dietary change or regular exercise

  12. Ratio’s based on Woolf’s data • Exercise/Tobacco Cessation • NNT = 1.78 • Preventable deaths = 1.84 • Lipids/Tobacco Cessation • NNT = 3.77 • Preventable deaths = 2.48 • Lipids/Exercise • NNT = 2.13 • Preventable deaths = 1.35

  13. Limitations • RRRs have wide confidence intervals • All deaths are not equally preventable • Model is binary, but health effects are continuous (e.g., exercise, all benefit) • Assumes complete adherence (unrealistic) • Total deaths after age 25 • Mortality vs. QALYs or CE

  14. Clinically Preventable Burden (CPB) • Proportion of disease and injury prevented if delivered to 100% of the target population • CPB is the product of the burden of disease targeted by the service and its effectiveness • Represented as Quality Adjusted Life Years (QALY)

  15. Cost Effectiveness (CE) • CE=(costs of prevention-costs averted) divided by the QALYs saved expressed in 1995 dollars • 13 services CE existed in published studies • 17 services this was estimated

  16. CPB and CE

  17. Priorities Among Services

  18. Ratios based on CPB • Tobacco Cessation/Exercise • CPB ratio = 1.67 • QALYs = 33.03 • Tobacco Cessation/Diet • CPB ratio = 2.50 • QALYS = 63.50 • Exercise/Diet • CPB = 1.50 • QALYs = 1.95

  19. Conclusion • Woolf indicates his model can use QALYs or CE to replace 30-year mortality, and adjust for intensity of intervention • 30-year mortality and clinically preventable burden allow broad comparisons across behavior change outcomes and other treatments for disease • Resulting comparisons are meaningful at policy as well as individual counseling levels

More Related