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Table 5 Potential clinical preventive services in BC. Range of cost-effectiveness estimates based on one-way sensitivity analysis

From: Priorities among effective clinical preventive services in British Columbia, Canada

Clinical Preventive Services

CEa (1.5% Discount Rate)

Key Variable(s)

Base Value

Range

Base

Range

Screening for Asymptomatic Disease or Risk Factors - Youth

 Screening for depression

$28,215

$21,555

$45,994

Reduction in quality of life due to depression

31%

15%

45%

Behavioural Counseling Interventions - Children/Youth

 Interventions to support breastfeeding

($9021)

($14,757)

$19,699

% of women attending interventions who exclusively breastfeed at 6 months

44%

13%

84%

 Growth monitoring and healthy weight management in children and youth

$29,436

$10,148

$524,527

Length of time that avoided costs accrue

Lifetime

10 Years

 

 Preventing tobacco use (school-aged children & youth)

($7349)

($10,083)

$23,905

% of smokers who cease as a result of intervention(s)

34%

5%

69%

Preventive Medication / Devices - Children

 Fluoride varnish

$43,038

$16,391

$86,076

Change in quality of life due to improved oral health

0.01

0.005

 

Frequency of fluoride varnish application

Every 6 months

 

Annually

 Dental sealants

($24,690)

($32,248)

($17,132)

Cost of dental fillings

$92.75

$83.10

$102.40

Screening for Asymptomatic Disease or Risk Factors - Adults

 Screening for breast cancer

$19,720

$11,659

$45,514

% reduction in breast cancer deaths as a result of mammogram screening

21%

10%

32%

 Screening (cytology-based) for cervical cancer

$25,542

$13,818

$99,328

Effectiveness of screening in reducing cervical cancer deaths / incidence

35% / 44%

10% / 25%

53% / 58%

 Addition of HPV-based cervical cancer screening

($21,556)

($16,414)

($23,377)

% improvement in HPV-screening effectiveness vs. cytology-based screening

55%

19%

75%

 Screening for colorectal cancer

$47,265

$32,923

$82,979

Effectiveness of screening in preventing colorectal cancer deaths

gFOBT - 18%

8%

27%

Colonoscopy - 26%

18%

33%

 Screening for lung cancer

$2240

$1228

$9206

% of lung cancer deaths avoided with screening

19.6%

7.7%

30.0%

 Screening for hypertension

$15,254

$9314

$24,485

Effectiveness of drug treatment in reducing cardiovascular and cerebrovascular events

Cardio - 22%

17%

29%

Cerebro - 41%

33%

48%

 Screening for cardiovascular disease risk and treatment (with statins)

$3223

$1458

$7849

Effectiveness of drug treatment in reducing all-cause mortality, myocardial infarction and stroke

Mortality - 14%

7%

20%

MI - 36%

29%

43%

Stroke - 29%

18%

38%

 Screening for type 2 diabetes mellitus (T2DM)

($3121)

($6348)

$1121

Proportion of office visit for screening

50%

33%

 

 Screening for depression in general adult population

Dominated

    

 Screening for depression in pregnant and postpartum women

$23,042

$11,149

$43,255

% reduction in depression risk due to screening

32%

18%

59%

 Screening for osteoporosis

($29,412)

($43,257)

$38,997

Change in the effectiveness of screening / treatment

   

Hip fracture reduction rate

23%

8%

$36

Vertebral fracture reduction rate

26%

12%

$38

 Screening for abdominal aortic aneurysm (AAA)

$11,995

$9328

$38,251

Change in the relative risk of AAA-related mortality

0.58

0.39

0.88

Screening for Sexually Transmitted Infections and Blood Borne Pathogens - Adults

 Screening for human immunodeficiency virus

$16,434

($12,463)

$80,739

% reduction in HIV transmission rate with early antiretroviral therapy

64%

25%

96%

 Screening for chlamydia and gonorrhea

$57,174

$37,189

$234,414

Effectiveness of screening in reducing pelvic pain, infertility and ectopic pregnancy

41%

10%

 

 Screening for hepatitis C virus

$3427

$2570

$5141

Probability of cirrhosis in Hepatitis C Virus positive individuals

15%

10%

20%

Behavioural Counseling Interventions - Adults

 Prevention of sexually transmitted infections (STIs)

$10,267

$6921

$22,513

Effectiveness of high intensity behavioural counselling interventions in reducing the incidence of STIs in adolescents and adults

Adolescents - 62%

40%

74%

Adults - 30%

13%

44%

 Counselling and interventions to prevent tobacco use

($1863)

($3441)

$779

Quit rate for smoking as a result of intervention

28.0%

23.0%

33.6%

 Screening and behavioural counseling interventions to reduce unhealthy alcohol use

$9609

($375)

$23,676

Frequency of screening

Annual

 

Every 5 yrs

Effectiveness of counselling in changing behaviour

13.9%

8.7%

 

 Screening for and management of obesity

$12,160

$5682

$28,565

Frequency of measuring of height / weight, physical activity and diet advice

Every 2 yrs

Annual

Every 3 yrs

 Preventing falls

$35,213

$13,950

$77,738

Cost of exercise per hour

$5.00

$0.00

$15.00

Preventive Medication / Devices - Adults

 Routine aspirin use for the prevention of cardiovascular disease (CVD) and colorectal cancer

$2302

-$1189

$24,255

Effectivenes of aspirin in reducing risk of cardiovascular disease, cerebrovascular disease, and colorectal cancer incidence and death

Cardio - 17%

6%

26%

Cerebro - 14%

2%

24%

CRC Incidence - 40%

24%

53%

CRC Mortality - 33%

14%

48%

 Folic acid supplementation for the prevention of neural tube defects

$195,379

$88,410

$431,770

Frequency of advice on folic acid supplementation

Annual

 

Every 3 yrs

  1. aCE Cost-effectiveness