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BCC Transbehavioral
Outcome Assessments
December 06, 200= 1
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Potential Outcomes
&#= 8226;Criterion
&= #8211;% of individuals who attain behavior goal
&#= 8226;Reduction in 30 mortality  Woolf, 1999&= #13;
= 226;Clinical Preventable Burden & Cost Effectiveness Coffield et = al., 2001
&= #8211;Quality adjusted life years saved (QALYs)
&= #8211;Net cost of service/QALYs
– <= /div>
•
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References
&#= 8226;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.
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Which Interventions Work Best?<= /b>
•Woolf recommends systematically comparing the relative effectiveness of = interventions in preventing disease outcomes
•Treatment of heart dis= ease reduces mortality by 21-33%
–Are these treatments m= ore or less likely to prevent death than smoking cessation or <= span style=3D'position:absolute;top:81.75%;left:16.66%;width:75.09%;height:6.0%= '>exercise?
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Policy and Personal Implication= s
•= For Policy Makers: Comparisons are important in terms of reducing number of deaths in the population.
•
•For Individuals: Comparisons inform personal choices.
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=
=
=
Projected Outcomes
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=
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Projected Outcomes
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Projected Outcomes
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Calculations
= 226;Population projections were derived by multiplying the number of deaths potentially preventable by the intervention by the <= span style=3D'position:absolute;top:48.0%;left:9.73%;width:86.89%;height:6.75%'= >preventable fraction
&= #8211;Preventable fraction=3D(p[1-RRR])/(RRR+p[1-RRR])
–p=3Dproportion of eligible population that has not received the intervention&= #13;
&= #8211;RRR=3Drelative risk reduction
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Calculations
•R= eduction of 30 year mortality
–A= bsolute 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 coh= ort of 45-year-old women= using annual mortality rates specified in the tables
–C= umulative death rates x RRR =3D 30 year probability of death with the intervention
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Comments
•Lifestyle changes of= fer much greater benefits when&n= bsp; compared to disease treatments •Offers ro= ugh approximation of benefits comparing tobacco cessation versus dietary change or regular exercise
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Ratio’s based on Woolf̵= 7;s data
•Exercise/Tobacco Cessation
–NNT  =3D 1.78
–Preventable deaths =3D= 1.84
•Lipids/Tobacco Cessation
–NNT =3D 3.77
–Preventable deaths =3D= 2.48
•Lipids/Exercise
–NNT =3D 2.13
–Preventable deaths =3D= 1.35
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Limitations
<= span class=3DBB style=3D'position:absolute;left:-4.65%'>•RRRs have= wide confidence intervals
•All deaths= are not equally preventable
•Model is b= inary, but health effects are continuous (e.g., exercise, all benefit)
<= span class=3DBB style=3D'position:absolute;left:-4.14%'>•Assumes c= omplete adherence (unrealistic)
•Total dea= ths after age 25
•Mortality= vs. QALYs or CE
•
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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)
•
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Cost Effectiveness (CE)
•CE=3D(costs of prevention-costs averted) divided by the QALYs saved expresse= d in 1995 dollars
<= span class=3DBB style=3D'position:absolute;left:-4.05%'>•13 servic= es CE existed in published studies
•17 servic= es this was estimated
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CPB and CE
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Priorities Among Services
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