- Open Access
Priorities among effective clinical preventive services in British Columbia, Canada
BMC Health Services Research volume 22, Article number: 564 (2022)
Despite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing.
We calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained.
Clinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services.
These results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
The Canadian Task Force on the Periodic Health Exam (later re-named the Canadian Task Force on Preventive Health Care - CTFPHC) began to review and rate clinical preventive services (CPS) in 1976 , and the US Preventive Services Task Force (USPSTF) took up and further developed this work starting in 1984 . Despite the long-standing experience of rating the evidence for CPS, the delivery of effective CPS in Canada and elsewhere is less than optimal [3,4,5]. Suggested reasons for this include health care providers’ lack of time, as well as the patient’s inability to find a provider and the lack of coordination across providers and settings [6, 7]. Yarnall estimated that 7.4 h of every primary care physician’s working day would be required to fully satisfy all the USPSTF ‘A’ and ‘B’ recommendations, based on a patient panel of 2500 with an age and sex distribution similar to that of the US population . An absence of policy and supportive management and payment systems is another factor in health systems focused on acute care .
The optimal delivery of CPS has important benefits for the health of the population. One study estimated that between 75,000 and 140,000 deaths could be avoided annually in the United States by increasing the use of nine CPS  while another estimated a saving of 2.6 million quality-adjusted life years in a US birth cohort of 4 million if utilization rates increased from current levels to 90% for 20 CPS .
The HealthPartners Institute in the US has attempted to reconcile the value of CPS with a provider’s lack of time, by prioritising effective CPS [11,12,13,14]. They note that the greatest population health improvement in the US could be gained by prioritizing CPS that address tobacco use, obesity-related behaviours and alcohol misuse .
Faced with this information and the lack of provincial policy on clinical preventive services in BC, the Ministry of Health established the Clinical Prevention Policy Review (CPPR) in January of 2007. The review process involved establishing a broad-based CPPR Expert Advisory Committee (the Committee), including experts from the US, the CTFPHC, the BC Medical Association (now Doctors of BC), the Canadian College of Family Physicians and others; Dr. Hans Krueger was hired as the lead consultant for the Committee.
The review asked three seemingly simple questions: What preventive manoeuvres are worth doing, what is the best way to deliver what is worth doing, and what systems need to be put in place to support delivery? While the technical reports  (and this article) focus primarily on the first question, the main report  also discussed the second and third questions, and these are further discussed towards the end of this article.
We prioritize 28 effective CPS in British Columbia, Canada using an adapted version of the approach developed by HealthPartners Institute . The policy goal is to guide decision-making by the BC Ministry of Health in initiating or expanding CPS within the province.
A CPS is defined as any maneuver(s) pertaining to primary and early secondary prevention (i.e., immunization, screening, counselling and preventive medication/device) offered to the general (asymptomatic) population based on age, sex and risk factors for disease and delivered on a one-provider-to-one-client basis, with two qualifications: (i) the provider could work as a member of a care team or as part of a system tasked with providing, for instance, a screening service; and (ii) the client could belong to a small group (e.g. a family, a group of smokers) that is jointly benefiting from the service.
A clinically preventable burden (CPB) is defined as the total quality adjusted life years (QALYs) that could be gained if the CPS were delivered at recommended intervals to a BC birth cohort of 40,000 individuals (the approximate number of annual births in BC) over the years of life that the service is recommended. Cost-effectiveness (CE) is defined as the net cost per QALY gained.
Selection of clinical preventive services for review
In 2006, the HealthPartners Institute published a study which ranked 25 evidence-based CPS on a scale of 2 (low priority) to 10 (high priority) . Of the 25 CPS, 15 received a rank of 6 or higher. In 2008, we requested and received Excel-based models for 10 of the 15 CPS. The 10 models were adjusted to incorporate available BC-specific data in calculating CPB and CE. In the adjusted models, we also used the difference between no service and the best utilization rate for that CPS observed in high-income countries (see Table 1), rather than the 90% utilization rate assumed in the HealthPartners modelling . This approach was chosen to better reflect actual benefits and costs associated with potentially achievable utilization rates.
In 2013 the Expert Advisory Committee requested modelling for an additional 9 CPS, followed by 4 in 2015. Each subsequent year the Committee chose 2-4 CPS to (re)model, based on updated CTFPHC or USPSTF results. In 2018, the Committee requested a revision of the CPS modelled to date to incorporate more recent data. In this 2018 update, all costs were adjusted to 2017 Canadian dollars. For consistency, all models completed or revised since 2018 have continued to provide the cost / QALY in 2017 Canadian dollars. The Committee only considered inclusion of preventive maneuvers with a ‘strong’ or ‘conditional (weak)’ recommendation’ by the CTFPHC  or an ‘A’ or ‘B’ rating by the USPSTF .
In order to prevent duplicate evidence reviews, the Committee agreed to refer any recommendations regarding immunizations to the British Columbia Communicable Disease Policy Committee  and any recommendations regarding prenatal care, intrapartum care and immediate postpartum and postnatal care (up to 8 weeks) to Perinatal Services BC , thus these CPS are not considered in this manuscript.
Table 1 provides a summary of the 28 CPS reviewed in BC to date. Included in the table are the relevant cohort and the frequency with which the service is to be provided. In addition, an estimated rate of coverage for the service in BC and the best in the world (BiW) are provided.
The primary variables in each model include the effectiveness of the intervention, the quality of life (QoL) values associated with the relevant health state(s) and the costs associated with implementing the intervention and/or avoiding the relevant health state(s).
Effectiveness of the intervention
Table 2 provides a summary of the effectiveness values (and the 95% CI) used in the modelling for each CPS. The effectiveness values are primarily based on evidence reviews completed for the CTFPHC or the USPSTF.
Quality of life values used in the modelling
The primary source for QoL values were the disability weights developed for the Global Burden of Disease study [95, 96] adjusted to reflect the mean QoL of the age- and sex-specific population under consideration [97, 98]. If disability weights were not available in the Global Burden of Disease study, then meta-analysis or larger studies assessing the QoL for a specific health-related outcome were used.
The CPB was calculated based on benefits minus known harms. For example, we included harms associated with unnecessary follow-up interventions associated with false positive screening results. Harms also include a modest reduction in QoL associated with taking any medication for preventive purposes [99,100,101].
Table 3 provides an overview of the QoL values used in the modelling.
Resource unit costs used in the modelling
In calculating CE, we included medical costs and costs to the individual. Medical costs included those associated with screening, counselling, pharmaceutical treatment and any follow-up diagnostic tests and treatments for both true- and false-positive findings. In the model assessing behavioural counselling and interventions for the prevention of alcohol misuse, we also included the costs associated with law enforcement, fire damage and motor vehicle collisions . In the model assessing folic acid supplementation for all women of reproductive age, we also included the special education and developmental service costs associated with caring for a child with a neural tube defect . While the definition of clinical prevention is independent of delivery mechanism or provider type, for costing purposes we chose to use a primary care physician’s office as the delivery mechanism when an established delivery mechanism was not in place in BC. We assumed that 50% of a 10-min visit would be required per CPS unless evidence indicated otherwise.
Costs to the individual include the value of a patient’s time required to travel to an appointment and receive both the CPS and needed follow-up procedures and is based on the average hourly wage rate in BC in 2017 plus 18% benefits . If the ‘50% of a 10-minute visit’ assumption applied, then only 50% of a patient’s time costs were included in the modelling. Overall costs were reduced by potential savings resulting from avoided treatments or less intensive treatments associated with earlier-stage medical care.
When integrating unit cost information into the analyses, priority was given to information available from BC, followed by the rest of Canada, then other high income countries with health care systems similar to Canada (e.g. the UK and Australia) and finally to unit cost information from the US. All unit costs were converted to 2017 Canadian dollars using the Campbell and Cochrane Economics Methods Group and the Evidence for Policy and Practice Information and Coordinating Centre Cost Converter [122, 123]. If US health care unit costs were used, these costs were reduced by 29% to reflect the substantially higher unit costs (or prices) in the US compared to those in Canada for the same output [124,125,126].
Table 4 provides an overview of the unit costs used in the modelling.
One-way sensitivity analysis, in which each major variable or assumption in the model was modified, was performed to assess the robustness of the results. We used 95% confidence intervals (CIs) to inform the range for these variables in our sensitivity analyses when the 95% CIs were available. QALYs are not discounted in calculating CPB but both QALYs and costs are discounted by 1.5% in calculating CE, with this rate varied from 0 to 3% in the structural sensitivity analysis [189, 190].
Table 5 presents the range of CE estimates for each CPS together with key variables and the values for the key variables used in the base model and the sensitivity analyses.
Table 6 provides a summary of the CPB and CE associated with each of the 28 CPS maneuvers. The CPB columns identify the clinically preventable burden (in terms of QALYs) that is being achieved in BC based on current coverage, and the potential CPB if the best coverage rate in the world (BiW) is achieved. Note that coverage rates in BC are unknown for 21 of the 28 (75%) maneuvers. The CE columns identify the cost-effectiveness ratio associated with a service stated in terms of the cost per QALY, using both a 1.5% and a 0% discount rate. The top interventions in terms of CPB are screening for hypertension and screening for cardiovascular disease risk and treatment that would prevent 11,587 and 9370 QALYs lost per 40,000 individuals, respectively. The top interventions in terms of CE are screening women 65 and older for osteoporosis and the application of dental sealants on permanent teeth at the time of tooth eruption, which provide cost savings of $29,412 and $24,690 per QALY (with 1.5% discount), respectively.
The results for CPB and CE are displayed together in Fig. 1. The figure is divided into nine segments; from the lowest to highest population health impact and from more expensive to cost-saving. By arranging CPB and CE in this manner, services in the upper right segment have the most favourable combination of CPB and CE while services in the lower left segment have the least favourable combination. While no CPS fall into the high population impact / cost-saving segment, services that fall into the moderate population impact / cost-saving or high population impact / less expensive segments include prevention and cessation of tobacco use in both children/adolescents and adults; initiatives to improve exclusive breastfeeding to 6 months of age; screening for and treatment of hypertension; and screening for cardiovascular disease risk factors and the appropriate initiation of statins. Three additional CPS approach the moderate population impact / cost-saving or high population impact / less expensive segments, namely, alcohol misuse screening and brief counseling, one-time screening for HCV infection in BC adults born between 1945 and 1965, and screening for type 2 diabetes. Screening for osteoporosis, the application of dental sealants and the addition of screening for the human papillomavirus to cytology-based screening for cervical cancers, the CPS with the highest cost savings per QALY, fell in the lowest segment for population health impact.
The CBP and CE estimates were fairly stable for most CPS, but varied greatly for some (see Figs. 2 and 3). For example, for the CPS of primary care interventions aimed at smoking cessation among children and adolescents, the estimate of CBP varied from 606 to 8367 QALYs, and the cost-effectiveness estimates ranged from a cost of $23,905 / QALY to a savings of $10,083 / QALY.
Other CPS with large variation in the CE were screening women 65 and older for osteoporosis, screening adolescents and adults aged 15 to 65 years for infection with the human immunodeficiency virus, growth monitoring and healthy weight management in children and youth and screening females less than 30 years of age at increased risk for infection with chlamydia and gonorrhea. The most common reason for this variation is the uncertainty associated with the effectiveness of the intervention (see Table 5).
We have assessed the clinically preventable burden and cost-effectiveness ratio of 28 clinical preventive services in BC, Canada and found that the services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. Three additional CPS approach these high-value CPS, namely alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in BC adults born between 1945 and 1965, and screening for type 2 diabetes.
Research by the HealthPartners Institute also established that the two CPS addressing tobacco use in the US were the highest priority preventive services . Despite historically low rates of tobacco use in BC, which are the lowest of any province in Canada , tobacco use continues to exert an important influence on the ill-health of the population. Of greater concern is the varying range in the rate of tobacco use in the different geographic regions within BC, from 8.8 to 21.3% in 2011/12 . This suggests the need for equity-focused CPS interventions based on the principle of proportionate universality; preventive services should be universally available, but concentrated on populations with higher rates of the condition or behaviour being addressed .
Our analysis also indicates the high value of interventions to support exclusive breastfeeding to 6 months. There are substantial health benefits for both the infant and mother associated with exclusive breastfeeding [58, 120].
Research by the HealthPartners Institute assigned a high value to addressing obesity-related behaviours. Our results for these CPS are more modest, likely due to assumptions about potential coverage rates. Based on the best available information on utilization rates from high-income countries, we assumed that only 7.2% of children [194, 195] and 33% of adults  with obesity would complete the multiple sessions over a 1 year period required to achieve an effective intervention [ 11, 49]. These coverage rates compare to the assumption of 90% included in the HealthPartners Institute analysis .
The limitations associated with this analysis are common to all modeling studies . Models use data from a variety of sources and the results are only as good as the underlying data. By nature, models also simplify the causal chain so the assumptions made in doing so can have an important impact on results.
Another limitation is the ability to find BiW intervention rates for each CPS. Despite significant effort searching the academic and grey literature, together with expert input, it is not possible to determine whether or not the estimated BiW rates used in the models truly are the BiW. Furthermore, newer CPS such as lung cancer screening may currently have low screening rates that will improve over time. In this scenario, despite a BiW published screening rate of 6% , we assumed that the rate for lung cancer screening would eventually approximate rates associated with other cancer screening programs in BC (60%).
The definition of a CPS is independent of delivery mechanism(s) or provider type(s). Determining the most suitable delivery mechanism or provider type for each service is determined in subsequent phases of the policy cycle where decisions are made on whether and, if so, how to implement the CPS. In order to estimate the costs of providing the service and for consistency and comparability between the various CPS, we chose to use a general physician’s office as the delivery mechanism and provider type if an established delivery mechanism is not currently in place. Further work has started in determining if the effectiveness of the intervention changes based on who provides the intervention. For example, evidence indicates that brief behavioural counselling interventions to reduce unhealthy alcohol use are equally effective if provided by nurses, physicians or counsellors / mental health clinicians .
The results generated through this process provide a transparent and evidence informed approach to making decisions for the delivery of CPS. It is a key step in determining which CPS should be priorities for BC and is essential for creating a business plan for implementation. These results, however, should not be used in isolation. Actual changes to service provision should be undertaken only when this analysis, a detailed business plan and budget impact analysis are part of the process. These supplementary analyses are important in addressing further questions required in decision-making, such as the feasibility and total costs of enhancing current services or implementing new services and the potential impact on related services.
In BC, this work by the CPPR led to the province adopting a Lifetime Prevention Schedule (LPS), publishing a LPS Practice Guide and providing regular update reports . The work by the CPPR was also a key building block in developing and implementing a preventive services incentive fee for family physicians in the province (the Personal Health Risk Assessment fee ), which we believe is unique in Canada. This analysis has also been instrumental in the decision to launch a lung cancer screening program in BC . Finally, the development of business cases to enhance screening for tobacco smoking and alcohol misuse followed by a behavioural counselling intervention are currently in process.
While the results noted above enable us to say with some confidence what is worth doing, the second and third questions asked in our original report remain important: What is the best way to deliver these services and by whom, and what supporting systems need to be put in place to ensure high and equitable coverage of cost-effective services with a moderate to high population health impact? While this discussion has started in BC and key decisions are being made, more remains to be done, both in BC and across Canada. After all, if a CPS is worth doing, it is worth doing well.
Availability of data and materials
A write-up of the detailed modelling approach including all assumptions and results for each individual model are available online at the British Columbia – Lifetime Prevention Schedule website (https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/health-priorities/lifetime-prevention). In addition to the detailed results for each model included in the “LPS Update Report”, this website also includes a “Reference and Key Assumptions” document that details the methodology behind the Lifetime Prevention Schedule as well as key assumptions used throughout the process. The Excel-based detailed models are available from the lead author upon reasonable request and with permission of the British Columbia Ministry of Health.
Clinical preventive services
Clinically preventable burden
Canadian Task Force on Preventive Health Care
United States Preventive Services Task Force
Quality adjusted life years
Clinical Prevention Policy Review
Quality of life
Best coverage rate in the world
Gorber S, Singh H, Pottie K, et al. Process for guideline development by the reconstituted Canadian Task Force on Preventive Health Care. Can Med Assoc J. 2012;184(14):1575–81.
Lenzer J. Is the United States preventive services task force still a voice of caution? BMJ. 2017;356:j743.
McGlynn E, Asch S, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.
Shenson D, Adams M, Bolen J, et al. Routine checkups don’t ensure that seniors get preventive services. J Fam Pract. 2011;60(1):E1–10.
Smith H, Herbert C. Preventive practice among primary care physicians in British Columbia: relation to recommendations of the Canadian Task Force on the Periodic Health Examination. Can Med Assoc J. 1993;149(12):1795–800.
Ogden L, Richards C, Shenson D. Clinical preventive services for older adults: the interface between personal health care and public health services. Am J Public Health. 2012;102(3):419–25.
Pollack K, Krause K, Yarnall K, et al. Estimated time spent on preventive services by primary care physicians. BMC Health Serv Res. 2008;8(245). https://doi.org/10.1186/1472-6963-8-245.
Yarnall K, Pollack K, Ostbye T, et al. Primary care: is there enough time for prevention? Am J Public Health. 2003;93(4):635–41.
BC Clinical Prevention Policy Review Committee. A lifetime of Prevention. 2009. Available at https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/health-priorites/lifetime-prevention-schedule/cppr-lifetime-prevention-report-2009.pdf. Accessed Mar 2021.
Farley T, Dalal M, Mostashari F, et al. Deaths preventable in the U.S. by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38(6):600–9.
Maciosek M, LaFrance A, Dehmer S, et al. Updated priorities among effective clinical preventive services. Ann Fam Med. 2017;15(1):14–22.
Maciosek M, Coffield A, McGinnis M, et al. Methods for priority setting among clinical preventive services. Am J Prev Med. 2001;21(1):10–9.
Coffield A, Maciosek M, McGinnis J, et al. Priorities among recommended clinical preventive services. Am J Prev Med. 2001;21(1):1–9.
Maciosek M, Coffield A, Edwards N, et al. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006;31(1):52–61.
Technical reports and additional information about the Lifetime Prevention Schedule are available online at https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/health-priorities/lifetime-prevention. Accessed Mar 2021.
Lewandowski RE, O’Connor B, Bertagnolli A, et al. Screening for and diagnosis of depression among adolescents in a large health maintenance organization. Psychiatr Serv. 2016;67(6):636–41.
Lefèvre Å, Lundqvist P, Drevenhorn E, et al. Parents’ experiences of parental groups in Swedish child health-care: do they get what they want? J Child Health Care. 2016;20(1):46–54.
Hillman JB, Corathers SD, Wilson SE. Pediatricians and screening for obesity with body mass index: does level of training matter? Public Health Rep. 2009;124(4):561–7.
Arlene Cristall, Provincial Lead. The centre for healthy weights – Shapedown BC. 2020. Personal communication.
Jamal A, Dube S, Babb S, et al. Tobacco use screening and cessation assistance during physician office visits among persons aged 11–21 years—National Ambulatory Medical Care Survey, United States, 2004–2010. Morb Mortal Wkly Rep. 2014;63(2):71–9.
Buckingham S, John J. Recruitment and participation in preschool and school-based fluoride varnish pilots–the south central experience. Br Dent J. 2013;215(E8):1–4.
Veiga N, Pereira C, Ferreira P, et al. Prevalence of dental caries and fissure sealants in a Portuguese sample of adolescents. PLoS One. 2015;10(3):1–12.
National Cancer Institute. Screening and risk factors table: had a mammogram in the past 2 years. 2017. Available at https://statecancerprofiles.cancer.gov/risk/index.php. Accessed July 2017.
National Cancer Institute. Screening and risk factors table: Pap test in past 3 years, no hysterectomy. 2017. Available at https://statecancerprofiles.cancer.gov/risk/index.php. Accessed July 2017.
National Cancer Institute. Screening and risk factors table. 2017. Available at https://statecancerprofiles.cancer.gov/risk/index.php. Accessed Aug 2017.
Huo J, Shen C, Volk R, et al. Use of CT and chest radiography for lung cancer screening before and after publication of screening guidelines: intended and unintended uptake. J Am Med Assoc Intern Med. 2017;177(3):439–41.
Godwin M, Williamson T, Khan S, et al. Prevalence and management of hypertension in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network. Can Med Assoc J Open. 2015;3(1):E76–82.
England PH. Public health outcomes framework. 2017. Available at http://www.phoutcomes.info/search/health%20check#pat/6/ati/102/par/E12000004. Accessed Aug 2017.
Chang K, Lee J, Vamos E, et al. Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis. Can Med Assoc J. 2016;188(10):E228–38.
Helin-Salmivaara A, Lavikainen P, Korhonen M, et al. Long-term persistence with statin therapy: a nationwide register study in Finland. Clin Ther. 2008;30(1):2228–40.
Hellgren M, Petzold M, Björkelund C, et al. Feasibility of the FINDRISC questionnaire to identify individuals with impaired glucose tolerance in Swedish primary care. A cross-sectional population-based study. Diabet Med. 2012;29(12):1501–5.
Van den Donk M, Sandbaek A, Borch-Johnsen K, et al. Screening for type 2 diabetes. Lessons from the ADDITION-Europe study. Diabet Med. 2011;28(11):1416–24.
Rui P, Hing E, Okeyode T. National ambulatory medical care survey: 2014 state and national summary tables. Available at http://www.cdc.gov/nchs/ahcd/ahcd_products.htm. Accessed Aug 2017.
Delatte R, Cao H, Meltzer-Brody S, et al. Universal screening for postpartum depression: an inquiry into provider attitudes and practice. Am J Obstet Gynecol. 2009;200(5):e63–e4.
Amarnath A, Franks P, Robbins J, et al. Underuse and overuse of osteoporosis screening in a regional health system: a retrospective cohort study. J Gen Intern Med. 2015;12(30):1733–40.
Jacomelli J, Summers L, Stevenson A, et al. Impact of the first 5 years of a national abdominal aortic aneurysm screening programme. Br J Surg. 2016;103(9):1125–31.
Van Handel M, Branson B. Monitoring HIV testing in the United States: consequences of methodology changes to national surveys. PLoS One. 2015;10(4):1–12.
England PH. Sexually transmitted infections (STIs): annual data tables. 2017. Available at https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables. Accessed Aug 2017.
Health Protection Agency. HIV in the United Kingdom: 2012 report. 2012. Available at http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317137200016. Accessed Aug 2017.
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2015. Atlanta: U.S. Department of Health and Human Services; 2016. Available online at https://www.cdc.gov/std/stats15/STD-Surveillance-2015-print.pdf. Accessed Aug 2017
Cullen B, Hutchison S, Cameron S, et al. Identifying former injecting drug users infected with hepatitis C: an evaluation of a general practice-based case-finding intervention. J Public Health. 2012;34(1):14–23.
Tyler C, Warner L, Gavin L, et al. Receipt of reproductive health services among sexually experienced persons aged 15–19 years—national survey of family growth, United States, 2006–2010. Morb Mortal Wkly Rep. 2014;63(2):2–5.
Kruger J, Shaw L, Kahende J, et al. Health care providers’ advice to quit smoking, national health interview survey, 2000, 2005, and 2010. Prev Chronic Dis. 2012;9:E130.
Bradley K, Williams E, Achtmeyer C, et al. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care. 2006;12:597–606.
Wangberg SC. Norwegian midwives’ use of screening for and brief interventions on alcohol use in pregnancy. Sex Reprod Healthc. 2015;6(3):186–90.
McCarty D, Gu Y, Renfro S, et al. Access to treatment for alcohol use disorders following Oregon’s health care reforms and Medicaid expansion. J Subst Abus Treat. 2018;94:24–8.
Fitzpatrick S, Stevens V. Adult obesity management in primary care, 2008–2013. Prev Med. 2017;99:128–33.
Fitzpatrick S, Dickins K, Avery E, et al. Effect of an obesity best practice alert on physician documentation and referral practices. Transl Behav Med. 2017:1–10.
Stevens J, Ballesteros M, Mack K, et al. Gender differences in seeking care for falls in the aged Medicare population. Am J Prev Med. 2012;43(1):59–62.
Kantor E, Rehm C, Du M, et al. Trends in dietary supplement use among US adults from 1999-2012. J Am Med Assoc. 2016;316(14):1464–74.
Fiscella K, Winters P, Mendoza M, et al. Do clinicians recommend aspirin to patients for primary prevention of cardiovascular disease? J Gen Intern Med. 2013;30(2):155–60.
Malayala S, Raza A. Compliance with USPSTF recommendations on aspirin for prevention of cardiovascular disease in men. Int J Clin Pract. 2016;70(11):898–906.
Canadian Task Force on Preventive Health Care. Procedure manual. 2014. Available at https://canadiantaskforce.ca/wp-content/uploads/2016/12/procedural-manual-en_2014_Archived.pdf. Accessed Mar 2021.
Kurth A, Krist A, Borsky A, et al. U.S. Preventive Services Task Force methods to communicate and disseminate clinical preventive services recommendations. Am J Prev Med. 2018;54(1S1):S81–7.
See http://www.bccdc.ca/health-professionals/clinical-resources/communicable-disease-control-manual/immunization. Accessed Mar 2021.
See http://www.perinatalservicesbc.ca/health-professionals/guidelines-standards. Accessed Mar 2021.
Forman-Hoffman V, McClure E, McKeeman J, et al. Screening for major depressive disorder in children and adolescents: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2016;164(5):342–9.
Chung M, Raman G, Trikalinos T, et al. Interventions in primary care to promote breastfeeding: an evidence review for the US Preventive Services Task Force. Ann Intern Med. 2008;149(8):565–82.
Canadian Task Force on Preventive Health Care. Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care. Can Med Assoc J. 2015;187(6):411–21.
US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417–26.
Canadian Task Force on Preventive Health Care. Recommendations on behavioural interventions for the prevention and treatment of smoking among school-aged children and youth. Can Med Assoc J. 2017;189(8):e310–6.
Marinho V, Worthington H, Walsh T, et al. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013. Available from https://doi.org/10.1002/14651858.CD002279.pub2.
Ahovuo-Saloranta A, Forss H, Walsh T, et al. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013. Available from https://doi.org/10.1002/14651858.CD001830.pub4.
Fitzpatrick-Lewis D, Hodgson N, Ciliska D, et al. Breast cancer screening. 2011. Available at http://canadiantaskforce.ca/wp-content/uploads/2012/09/Systematic-review.pdf?0136ff.
Peirson L, Fitzpatrick-Lewis D, Ciliska D, et al. Screening for cervical cancer: a systematic review and meta-analysis. Syst Rev. 2013;2(35). Available from https://link.springer.com/article/10.1186/2046-4053-2-35.
Ronco G, Dillner J, Elfström K, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014;383(9916):524–32.
Canadian Task Force on Preventive Health Care. Recommendations on screening for colorectal cancer in primary care. Can Med Assoc J. 2016;188(5):340–8.
National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.
Law M, Morris J, Wald N. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. Br Med J. 2009;338. https://doi.org/10.1136/bmj.b1665.
Chou R, Dana T, Blazina I, et al. Statins for prevention of cardiovascular disease in adults: evidence report and systematic review for the US Preventive Services Task Force. J Am Med Assoc. 2016;316(19):2008–24.
Kahn R, Alperin P, Eddy D, et al. Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis. Lancet. 2010;375(9723):1365–74.
Colman I, Zeng Y, Ataullahjan A, et al. The association between antidepressant use and depression eight years later: a national cohort study. J Psychiatr Res. 2011;45(8):1012–8.
O’Connor E, Rossom RC, Henninger M, et al. Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(4):388–406.
Curry S, Krist A, Owens D, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. J Am Med Assoc. 2018;319(24):2521–31.
Patrick A, Brookhart M, Losina E, et al. The complex relation between bisphosphonate adherence and fracture reduction. J Clin Endocrinol Metab. 2010;95(7):3251–9.
Girguis-Blake J, Beil T, Sun X et al. Primary care screening for abdominal aortic aneurysm: a systematic evidence review for the US Preventive Services Task Force. Evidence synthesis no. 109. 2014: Available at https://www.ncbi.nlm.nih.gov/books/NBK184793/.
Cohen M, Chen Y, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
Anglemyer A, Rutherford G, Horvath T, et al. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev. 2013. Available from https://doi.org/10.1002/14651858.CD009153.pub3.
Hu D, Hook E, Goldie S. Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis. Ann Intern Med. 2004;141(7):501–13.
Jacobson I, Lawitz E, Gane E, et al. Efficacy of 8 weeks of sofosbuvir, velpatasvir, and voxilaprevir in patients with chronic HCV infection: 2 phase 3 randomized trials. Gastroenterology. 2017;153(1):113–22.
Feld J, Jacobson I, Hézode C, et al. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373(27):2599–607.
Foster G, Afdhal N, Roberts S, et al. Sofosbuvir and velpatasvir for HCV genotype 2 and 3 infection. N Engl J Med. 2015;373(27):2608–17.
Zeuzem S, Ghalib R, Reddy K, et al. Grazoprevir–elbasvir combination therapy for treatment-naive cirrhotic and noncirrhotic patients with chronic hepatitis C virus genotype 1, 4, or 6 infection: a randomized trial. Ann Intern Med. 2015;163(1):1–13.
Asselah T, Kowdley K, Zadeikis N, et al. Efficacy of glecaprevir/pibrentasvir for 8 or 12 weeks in patients with hepatitis C virus genotype 2, 4, 5, or 6 infection without cirrhosis. Clin Gastroenterol Hepatol. 2018;16(3):417–26.
Zeuzem S, Foster G, Wang S, et al. Glecaprevir–pibrentasvir for 8 or 12 weeks in HCV genotype 1 or 3 infection. N Engl J Med. 2018;378(4):354–69.
O’Connor E, Lin J, Burda B, et al. Behavioral sexual risk-reduction counselling in primary care to prevent sexually transmitted infections: an updated systematic evidence review for the US Preventive Services Task Force. Ann Intern Med. 2014;161(12):874.
Smith A, Chapman S. Quitting smoking unassisted: the 50-year research neglect of a major public health phenomenon. J Am Med Assoc. 2014;311(2):137–8.
Fiore M, Jaen C, Baker T, et al. Clinical practice guideline. Treating tobacco use and dependence: 2008 update: U.S. Department of Health and Human Services; 2008. Available at http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/treating_tobacco_use08.pdf
Curry SJ, Krist AH, Owens DK, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. J Am Med Assoc. 2018;320(18):1899–909.
Peirson L, Douketis J, Ciliska D, et al. Treatment for overweight and obesity in adult populations: a systematic review and meta-analysis. Can Med Assoc Open Access J. 2014;2(4):e306–e17.
Michael Y, Whitlock E, Lin J, et al. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153(12):815–25.
Guirguis-Blake J, Evans C, Senger C, et al. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164(12):804–13.
Chubak J, Whitlock E, Williams S, et al. Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164(12):814–25.
De-Regil L, Peña-Rosas J, Fernández-Gaxiola A, et al. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2015. Available from https://doi.org/10.1002/14651858.CD007950.pub3.
Salomon J, Haagsma J, Davis A, et al. Disability weights for the global burden of diseases 2013 study. Lancet Glob Health. 2015;3:e712–23.
Institute for Health Metrics and Evaluation. GBD 2016 sequelae, health states, health state lay descriptions, and disability weights. Available online at http://ghdx.healthdata.org/record/global-burden-disease-study-2016-gbd-2016-disability-weights. Accessed Mar 2021.
Sullivan P, Ghushchyan V. Preference-based EQ-5D index scores for chronic conditions in the United States. Med Decis Mak. 2006;26(4):410–20.
Sullivan PW, Slejko JF, Sculpher MJ, et al. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Mak. 2011;31(6):800–4.
Thompson A, Guthrie B, Payne K. Do pills have no ills? Capturing the impact of direct treatment disutility. PharmacoEconomics. 2016;34(4):333–6.
Hutchins R, Pignone M, Sheridan S, et al. Quantifying the utility of taking pills for preventing adverse health outcomes: a cross-sectional survey. Br Med J Open. 2015;5(e006505):1–9.
Hutchins R, Viera AJ, Sheridan SL, et al. Quantifying the utility of taking pills for cardiovascular prevention. Circ Cardiovasc Qual Outcomes. 2015;8(2):155–63.
Fitzmaurice C, Allen C, Barber R, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. J Am Med Assoc Oncol. 2017;3(4):524–48.
Dormal V, Bremhorst V, Lannoy S, et al. Binge drinking is associated with reduced quality of life in young students: a pan-European study. Drug Alcohol Depend. 2018;193:48–54.
Schousboe J, Kerlikowske K, Loh A, et al. Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness. Ann Intern Med. 2011;155(1):10–20.
Insinga R, Glass A, Myers E, et al. Abnormal outcomes following cervical cancer screening: event duration and health utility loss. Med Decis Mak. 2007;27(4):414–22.
Krueger H, Lindsay P, Cote R, et al. Cost avoidance associated with optimal stroke care in Canada. Stroke. 2012;43(8):2198–206.
Chapman K, Ernst P, Grenville A, et al. Control of asthma in Canada: failure to achieve guideline targets. Can Respir J. 2001;8(Suppl A):35A–40A.
Whiteford H, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013;382(9904):1575–86.
Stade B, Stevens B, Ungar W, et al. Health-related quality of life of Canadian children and youth prenatally exposed to alcohol. Health Qual Life Outcomes. 2006;4:81.
Campbell H, Stokes E, Bargo D, et al. Costs and quality of life associated with acute upper gastrointestinal bleeding in the UK: cohort analysis of patients in a cluster randomised trial. Br Med J Open. 2015;5(4):e007230.
Hsu PC, Federico CA, Krajden M, et al. Health utilities and psychometric quality of life in patients with early-and late-stage hepatitis C virus infection. J Gastroenterol Hepatol. 2012;27(1):149–57.
Ratcliffe J, Longworth L, Young T, et al. Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. Liver Transpl. 2002;8(3):263–70.
Ul-Haq Z, Mackay D, Fenwick E, et al. Meta-analysis of the association between body mass index and health-related quality of life among children and adolescents, assessed using the pediatric quality of life inventory index. J Pediatr. 2013;162(2):280–6.
Lamb T, Frew E, Ives N, et al. Mapping the paediatric quality of life inventory (PedQL™) generic core scales onto the child health utility index-9 dimension (CHU-9D) score for economic evaluation in children. PharmacoEconomics. 2018;36:451–65.
Maheswaran H, Petrou S, Rees K, et al. Estimating EQ-5D utility values for major health behavioural risk factors in England. J Epidemiol Community Health. 2013;67(1):172–80.
Bertram M, Norman R, Kemp L, et al. Review of the long-term disability associated with hip fractures. Inj Prev. 2011;17:365–70.
Kanis J, Oden A, Johnell O, et al. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int. 2001;12(5):417–27.
Grosse S, Flores A, Ouyang L, et al. Impact of spina bifida on parental caregivers: findings from a survey of Arkansas families. J Child Fam Stud. 2009;18(5):574–81.
Rehm J, Gnam W, Popova S, et al. The costs of alcohol, illegal drugs, and tobacco in Canada, 2002. J Stud Alcohol Drugs. 2007;68(6):886–95.
Grosse S, Berry R, Tilford J, et al. Retrospective assessment of cost savings from prevention: folic acid fortification and spina bifida in the US. Am J Prev Med. 2016;50(5S1):S74–80.
Statistics Canada. Average hourly wages of employees by selected characteristics and occupation, unadjusted data, by province (monthly) (British Columbia). 2017. Available at http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/labr69k-eng.htm. Accessed Mar 2021.
Shemilt I, Thomas J, Morciano M. A web-based tool for adjusting costs to a specific target currency and price year. Evid Policy. 2010;6(1):51–9.
The Campbell and Cochrane Economics Methods Group and Evidence for Policy and Practice Information and Coordinating Centre. CCEMG - EPPI-centre cost converter. 2021. Available at https://eppi.ioe.ac.uk/costconversion/. Accessed Dec 2021.
Papanicolas I, Woskie L, Jha A. Health care spending in the United States and other high-income countries. JAMA. 2018;319(10):1024–39.
Anderson G, Reinhardt U, Hussey P, et al. It’s the prices, stupid: why the United States is so different from other countries. Health Aff. 2003;22(3):89–105.
Reinhardt U. Why does US health care cost so much? (part I). 2008. Available at https://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/. Accessed July 2017.
Ministry of Health. Medical services commission payment schedule. 2016. Available at http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/msc-payment-schedule-december-2016.pdf.
Giardina S, Pane B, Spinella G, et al. An economic evaluation of an abdominal aortic aneurysm screening program in Italy. J Vasc Surg. 2011;54(4):938–46.
Silverstein M, Pitts S, Chaikof E, et al. Abdominal aortic aneurysm (AAA): cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Bayl Univ Med Cent Proc. 2005;18(4):345–67.
Burgers L, Vahl A, Severens J, et al. Cost-effectiveness of elective endovascular aneurysm repair versus open surgical repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2016;52(1):29–40.
Visser J, van Sambeek M, Hunink M, et al. Acute abdominal aortic aneurysms: cost analysis of endovascular repair and open surgery in hemodynamically stable patients with 1-year follow-up. Radiology. 2006;240(3):681–9.
Svensjö S, Mani K, Björck M, et al. Screening for abdominal aortic aneurysm in 65-year-old men remains cost-effective with contemporary epidemiology and management. Eur J Vasc Endovasc Surg. 2014;47(4):357–65.
H. Krueger & Associates Inc. The economic burden of risk factors in British Columbia: excess weight, tobacco smoking, alcohol use, physical inactivity and low fruit and vegetable consumption. Vancouver: Provincial Health Services Authority, Population and Public Health Program; 2017.
Canadian Substance Use Costs and Harms Scientific Working Group. Canadian substance use costs and harms in the provinces and territories (2007 – 2014). Ottawa: Prepared by the Canadian Institute for Substance Use Research and the Canadian Centre on Substance Use and Addiction; 2018.
Stade B, Ali A, Bennett D, et al. The burden of prenatal exposure to alcohol: revised measurement of cost. Can J Clin Pharmacol. 2009;16(1):e91–e102.
Barbeau M, Lalonde H. Burden of atopic dermatitis in Canada. Int J Dermatol. 2006;45(1):31–6.
BC Cancer Agency. Screening mammography program: 2016 annual report. 2016. Available at http://www.bccancer.bc.ca/screening/Documents/SMP_Report-AnnualReport2016.pdf.
Gocgun Y, Banjevic D, Taghipour S, et al. Cost-effectiveness of breast cancer screening policies using simulation. Breast. 2015;24(4):440–8.
de Oliveira C, Bremner K, Pataky R, et al. Understanding the costs of cancer care before and after diagnosis for the 21 most common cancers in Ontario: a population-based descriptive study. Can Med Assoc J Open. 2013;1(1):E1–8.
Wai E, Trevisan C, Taylor S, et al. Health system costs of metastatic breast cancer. Breast Cancer Res Treat. 2001;65(3):233–40.
Broekx S, Den Hond E, Torfs R, et al. The costs of breast cancer prior to and following diagnosis. Eur J Health Econ. 2011;12(4):311–7.
Kulasingam S, Rajan R, St Pierre Y, et al. Human papillomavirus testing with Pap triage for cervical cancer prevention in Canada: a cost-effectiveness analysis. BMC Med. 2009;7(1):69.
Brisson M, Van de Velde N, De Wals P, et al. The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine. 2007;25(29):5399–408.
Krahn M, McLauchlin M, Pham B, et al. Liquid-based techniques for cervical cancer screening: systematic review and cost-effectiveness analysis. 2008. Available at https://www.cadth.ca/sites/default/files/pdf/333_LBC-Cervical-Cancer-Screenin_tr_e.pdf. Accessed Aug 2017.
Popadiuk C, Gauvreau C, Bhavsar M, et al. Using the Cancer Risk Management Model to evaluate the health and economic impacts of cytology compared with human papillomavirus DNA testing for primary cervical cancer screening in Canada. Curr Oncol. 2016;23(Supp.1):S56–63.
Sander B, Wong W, Yeung M, et al. The cost-utility of integrated cervical cancer prevention strategies in the Ontario setting–can we do better? Vaccine. 2016;34(16):1936–44.
Mariotto A, Robin Y, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst. 2011;103(2):117–28.
Cressman S, Lam S, Tammemagi MC, et al. Resource utilization and costs during the initial years of lung cancer screening with computed tomography in Canada. J Thorac Oncol. 2014;9(10):1449–58.
Ministry of Health. Cardiovascular disease – primary prevention. 2014. Available at http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/cvd.pdf.
See BC Reference Drug Program. Available online at http://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/prescribers/reference-drug-program.
Pandya A, Sy S, Cho S, et al. Cost-effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. J Am Med Assoc. 2015;314(2):142–50.
Dehmer S, Maciosek M, LaFrance A, et al. Health benefits and cost-effectiveness of asymptomatic screening for hypertension and high cholesterol and aspirin counseling for primary prevention. Ann Fam Med. 2017;15(1):23–36.
Gloede T, Halbach S, Thrift A, et al. Long-term costs of stroke using 10-year longitudinal data from the north East Melbourne stroke incidence study. Stroke. 2014;45(11):3389–94.
Sadatsafavi M, Lynd L, Marra C, et al. Direct health care costs associated with asthma in British Columbia. Can Respir J. 2010;17(2):74–80.
Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010;125(5):e1048–e56.
BC Ministry of Social Development and Poverty Reduction. Dental supplement. 2017. Available online at https://www2.gov.bc.ca/assets/gov/family-and-social-supports/income-assistance/on-assistance/schedule-dentist.pdf.
Canadian Institute for Health Information. Treatment of preventable dental cavities in preschoolers: a focus on day surgery under general anesthesia. 2013. Available at https://secure.cihi.ca/free_products/Dental_Caries_Report_en_web.pdf.
Morgan S, Smolina K, Mooney D, et al. The Canadian Rx Atlas, third edition: UBC Centre for Health Services and Policy Research; 2013. Available at http://www.chspr.ubc.ca/sites/default/files/file_upload/publications/2013/RxAtlas/canadianrxatlas2013.pdf
Pacific Blue Cross. Pharmacy compass. 2018. Available at https://www.pac.bluecross.ca/pharmacycompass.
Wright D, Katon WJ, Ludman E, et al. Association of adolescent depressive symptoms with health care utilization and payer-incurred expenditures. Acad Pediatr. 2016;16(1):82–9.
Shepard D, Gurewich D, Lwin AK, et al. Suicide and suicidal attempts in the United States: costs and policy implications. Suicide Life Threat Behav. 2016;46(3):352–62.
Clayton D, Barcel A. The cost of suicide mortality in New Brunswick, 1996. Chronic Dis Can. 1999;20(2):89–95.
Kinchin I, Doran CM. The cost of youth suicide in Australia. Int J Environ Res Public Health. 2018;15(4):672–82.
BC Ministry of Health. MSP fee-for-service payment analysis. 2012/2013 - 2016/2017. Available online at https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/ffs_complete.pdf.
Frick K, Gower E, Kempen J, et al. Economic impact of visual impairment and blindness in the United States. Arch Ophthalmol. 2007;125(4):544–50.
O’Brien JA, Patrick AR, Caro JJ. Cost of managing complications resulting from type 2 diabetes mellitus in Canada. BMC Health Serv Res. 2003;3(1):7.
Comay D, Marshall J. Resource utilization for acute lower gastrointestinal hemorrhage: the Ontario GI bleed study. Can J Gastroenterol. 2002;16(10):677–82.
Ball T, Wright A. Health care costs of formula-feeding in the first year of life. Pediatrics. 1999;103(Suppl. 1):870–6.
El Saadany S, Coyle D, Giulivi A, et al. Economic burden of hepatitis C in Canada and the potential for prevention. Eur J Health Econ. 2005;6:159–65.
Myers R, Krajden M, Bilodeau M, et al. Burden of disease and cost of chronic hepatitis C virus infection in Canada. Can J Gastroenterol Hepatol. 2014;28(5):243–50.
Douglass CH, Pedrana A, Lazarus JV, et al. Pathways to ensure universal and affordable access to hepatitis C treatment. BMC Med. 2018;16(1):175.
Hurley R. Slashed cost of hepatitis C drugs spurs drive to eliminate the disease. BMJ. 2018;361:k1679.
Williams J, Miners A, Harris R, et al. The cost-effectiveness of one-time birth cohort screening for hepatitis C as part of the national health service health check programme in England. Value Health. 2019;22(11):1248–56.
Taylor M, Grieg P, Detsky A, et al. Factors associated with the high cost of liver transplantation in adults. Can J Surg. 2002;45(6):425–34.
Kingston-Riechers J. The economic cost of HIV/AIDS in Canada: Canadian AIDS Society; 2011. Available online at http://www.cdnaids.ca/files.nsf/pages/economiccostofhiv-aidsincanada/$file/Economic%20Cost%20of%20HIV-AIDS%20in%20Canada.pdf
Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment – United States, 2003. MMWR Wkly. 2003;53(03):57–9.
Jaquier M, Klein A, Boltshauser E. Spontaneous pregnancy outcome after prenatal diagnosis of anencephaly. BJOG. 2006;113(8):951–3.
Canadian Institute for Health Information. Patient cost estimator. Available online at https://www.cihi.ca/en/spending-and-health-workforce/spending/patient-cost-estimator.
Karen Strange, Project Director. Generation Health, Childhood Obesity Foundation. 2020. Personal communication.
Gustafson A, Khavjou O, Stearns SC, et al. Cost-effectiveness of a behavioral weight loss intervention for low-income women: the weight-wise program. Prev Med. 2009;49(5):390–5.
Krukowski R, Tilford J, Harvey-Berino J, et al. Comparing behavioral weight loss modalities: incremental cost-effectiveness of an internet-based versus an in-person condition. Obesity. 2011;19(8):1629–35.
Neumann A, Schwarz P, Lindholm L. Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany: Markov modelling. Cost Eff Resour Alloc. 2011;9(1):17.
B.C. Ministry of Health, Health Sector Information, Analysis & Reporting Division. MSP fee-for-service payment analysis 2012/2013 - 2016/2017. 2017. Available at https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/ffs_complete.pdf.
Hopkins R, Burke N, Von Keyserlingk C, et al. The current economic burden of illness of osteoporosis in Canada. Osteoporos Int. 2016;27(10):3023–32.
Coyte P, Asche C, Elden L. The economic cost of otitis media in Canada. Int J Pediatr Otorhinolaryngol. 1999;49(1):27–36.
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40(3):197–201.
BC Ministry of Health. Effective pharmacological aids to smoking cessation. 2011. Available at http://www.health.gov.bc.ca/pharmacare/pdf/sc-prod-info.pdf.
Canadian Agency for Drugs and Technologies in Health Methods and Guidelines. Guidelines for the economic evaluation of health technologies. Canada; 2017. Available at https://www.cadth.ca/guidelines-economic-evaluation-health-technologies-canada-4th-edition. Accessed Mar 2021
The National Institute for Health and Care Excellence (NICE). Methods for the development of NICE public health guidance (third edition). Available at https://www.nice.org.uk/process/pmg4/chapter/incorporating-health-economics. Accessed Mar 2021.
Krueger H, Krueger J, Koot J. Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can J Public Health. 2015;106(4):e171–7.
Krueger H, Koot J, Rasali D, et al. Regional variation in the economic burden attributable to excess weight, physical inactivity and tobacco smoking across British Columbia. Health Promot Chronic Dis Prev Can. 2016;36(4):76–86.
Marmot M, Goldblatt P, Allen J, et al. Fair society healthy lives (the Marmot review): Institute of Health Equity; 2010. Available online at http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review. Accessed Mar 2021
Fagg J, Chadwick P, Cole T, et al. From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale. Int J Obes. 2014;38(10):1343–9.
Margaret Yandel, Policy Lead. Office of the Provincial Dietitian. 2020. Personal communication.
Moyer VA. Screening for and management of obesity in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373–8.
Enderling H, Wolkenhauer O. Are all models wrong? Comput Syst Oncol. 2021;1:e1008.
Platt L, Melendez-Torres G, O’Donnell A, et al. How effective are brief interventions in reducing alcohol consumption: Do the setting, practitioner group and content matter? Findings from a systematic review and meta-regression analysis. BMJ Open. 2016;6:e011473.
GPSC Services Committee. Prevention incentives. 2018. Available online at http://www.gpscbc.ca/sites/default/files/uploads/GPSC%20Billing%20Guide%20-%20Prevention%20201801.pdf. Accessed Mar 2021.
BC Cancer. B.C. launches lung cancer screening program – the first in Canada. 2020. Available online at http://www.bccancer.bc.ca/about/news-stories/news/2020/b-c-launches-lung-cancer-screening-program-%E2%80%93-the-first-in-canada. Accessed Mar 2021.
We are grateful to the HealthPartners Institute and in particular Dr. Michael Maciosek, who allowed us to use their original US-based models and data and adapt them for our own use in British Columbia.
Hans Krueger received funding from the BC Ministry of Health in carrying out this work.
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This research is based on modeling the effects and costs of 28 CPS using a theoretical birth cohort of 40,000 individuals born in British Columbia. As such, no actual identifiable individuals were participants in the study.
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Krueger, H., Robinson, S., Hancock, T. et al. Priorities among effective clinical preventive services in British Columbia, Canada. BMC Health Serv Res 22, 564 (2022). https://doi.org/10.1186/s12913-022-07871-0