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. 1994 Mar-Apr;109(2):187–194.

Assessing prevention effectiveness using data to drive program decisions.

S B Thacker 1, J P Koplan 1, W R Taylor 1, A R Hinman 1, M F Katz 1, W L Roper 1
PMCID: PMC1403474  PMID: 8153269

Abstract

The measure of the effectiveness of health promotion and disease prevention activities is the impact of prevention policies, programs, and practices on public health and clinical medicine. Assessing prevention effectiveness involves continuing quantitative analysis of health outcomes resulting from prevention practices. Additionally, assessment involves evaluation of disease- and injury-prevention activities, including their medical, legal, ethical, and economic impacts. Although assessing the effectiveness of prevention activities involves measuring efficacy, safety, and cost, the primary criterion is to improve health at a reasonable cost, not merely to contain costs. Policy makers can use the results of assessments to set priorities in public health. The authors use case studies to illustrate various approaches to evaluating prevention programs, including programs for preventing measles, breast cancer, and diabetic retinopathy. Rigorous evaluation of the effectiveness of prevention activities is essential to the wide acceptance of preventive interventions and the willingness to pay for them.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albritton R. B. Cost-benefits of measles eradication: effects of a federal intervention. Policy Anal. 1978 Winter;4(1):1–21. [PubMed] [Google Scholar]
  2. Banta H. D., Luce B. R. Assessing the cost-effectiveness of prevention. J Community Health. 1983 Winter;9(2):145–165. doi: 10.1007/BF01349877. [DOI] [PubMed] [Google Scholar]
  3. Banta H. D., Thacker S. B. The case for reassessment of health care technology. Once is not enough. JAMA. 1990 Jul 11;264(2):235–240. [PubMed] [Google Scholar]
  4. Bloch A. B., Orenstein W. A., Stetler H. C., Wassilak S. G., Amler R. W., Bart K. J., Kirby C. D., Hinman A. R. Health impact of measles vaccination in the United States. Pediatrics. 1985 Oct;76(4):524–532. [PubMed] [Google Scholar]
  5. Brown E. Y., Viscoli C. M., Horwitz R. I. Preventive health strategies and the policy makers' paradox. Ann Intern Med. 1992 Apr 1;116(7):593–597. doi: 10.7326/0003-4819-116-7-593. [DOI] [PubMed] [Google Scholar]
  6. Brown M. L., Kessler L. G., Rueter F. G. Is the supply of mammography machines outstripping need and demand? An economic analysis. Ann Intern Med. 1990 Oct 1;113(7):547–552. doi: 10.7326/0003-4819-113-7-547. [DOI] [PubMed] [Google Scholar]
  7. Burns-Cox C. J., Hart J. C. Screening of diabetics for retinopathy by ophthalmic opticians. Br Med J (Clin Res Ed) 1985 Apr 6;290(6474):1052–1054. doi: 10.1136/bmj.290.6474.1052. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bush P. J., Zuckerman A. E., Theiss P. K., Taggart V. S., Horowitz C., Sheridan M. J., Walter H. J. Cardiovascular risk factor prevention in black schoolchildren: two-year results of the "Know Your Body" program. Am J Epidemiol. 1989 Mar;129(3):466–482. doi: 10.1093/oxfordjournals.aje.a115158. [DOI] [PubMed] [Google Scholar]
  9. Carter A. P., Thompson R. S., Bourdeau R. V., Andenes J., Mustin H., Straley H. A clinically effective breast cancer screening program can be cost-effective, too. Prev Med. 1987 Jan;16(1):19–34. doi: 10.1016/0091-7435(87)90003-x. [DOI] [PubMed] [Google Scholar]
  10. Connell D. B., Turner R. R., Mason E. F. Summary of findings of the School Health Education Evaluation: health promotion effectiveness, implementation, and costs. J Sch Health. 1985 Oct;55(8):316–321. doi: 10.1111/j.1746-1561.1985.tb05656.x. [DOI] [PubMed] [Google Scholar]
  11. Dasbach E. J., Fryback D. G., Newcomb P. A., Klein R., Klein B. E. Cost-effectiveness of strategies for detecting diabetic retinopathy. Med Care. 1991 Jan;29(1):20–39. doi: 10.1097/00005650-199101000-00003. [DOI] [PubMed] [Google Scholar]
  12. Davis R. L., Gonser H. L., Kirkpatrick M. A., Lavery S. W., Owen S. L. Comprehensive school health education: a practical definition. J Sch Health. 1985 Oct;55(8):335–339. doi: 10.1111/j.1746-1561.1985.tb05659.x. [DOI] [PubMed] [Google Scholar]
  13. Diabetic retinopathy. N Engl J Med. 1990 Aug 30;323(9):613–614. doi: 10.1056/NEJM199008303230915. [DOI] [PubMed] [Google Scholar]
  14. Dodd G. D., Fink D. J., Bertram D. A. Addressing the needs and solutions to increase the use of low-cost screening mammography. Cancer. 1987 Oct 1;60(7 Suppl):1669–1670. doi: 10.1002/1097-0142(19871001)60:1+<1669::aid-cncr2820601202>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  15. Dwyer T., Viney R., Jones M. Assessing school health education programs. Int J Technol Assess Health Care. 1991;7(3):286–295. doi: 10.1017/s0266462300005675. [DOI] [PubMed] [Google Scholar]
  16. Eddy D. M., Hasselblad V., McGivney W., Hendee W. The value of mammography screening in women under age 50 years. JAMA. 1988 Mar 11;259(10):1512–1519. [PubMed] [Google Scholar]
  17. Eddy D. M. Screening for breast cancer. Ann Intern Med. 1989 Sep 1;111(5):389–399. doi: 10.7326/0003-4819-111-5-389. [DOI] [PubMed] [Google Scholar]
  18. Foulds W. S., McCuish A., Barrie T., Green F., Scobie I. N., Ghafour I. M., McClure E., Barber J. H. Diabetic retinopathy in the West of Scotland: its detection and prevalence, and the cost-effectiveness of a proposed screening programme. Health Bull (Edinb) 1983 Nov;41(6):318–326. [PubMed] [Google Scholar]
  19. Hayward R. S., Steinberg E. P., Ford D. E., Roizen M. F., Roach K. W. Preventive care guidelines: 1991. American College of Physicians. Canadian Task Force on the Periodic Health Examination. United States Preventive Services Task Force. Ann Intern Med. 1991 May 1;114(9):758–783. doi: 10.7326/0003-4819-114-9-758. [DOI] [PubMed] [Google Scholar]
  20. Hinman A. R. What will it take to fully protect all American children with vaccines? Am J Dis Child. 1991 May;145(5):559–562. doi: 10.1001/archpedi.1991.02160050085023. [DOI] [PubMed] [Google Scholar]
  21. Javitt J. C., Canner J. K., Sommer A. Cost effectiveness of current approaches to the control of retinopathy in type I diabetics. Ophthalmology. 1989 Feb;96(2):255–264. doi: 10.1016/s0161-6420(89)32923-x. [DOI] [PubMed] [Google Scholar]
  22. Katz S., Akpom C. A. A measure of primary sociobiological functions. Int J Health Serv. 1976;6(3):493–508. doi: 10.2190/UURL-2RYU-WRYD-EY3K. [DOI] [PubMed] [Google Scholar]
  23. Katz S., Branch L. G., Branson M. H., Papsidero J. A., Beck J. C., Greer D. S. Active life expectancy. N Engl J Med. 1983 Nov 17;309(20):1218–1224. doi: 10.1056/NEJM198311173092005. [DOI] [PubMed] [Google Scholar]
  24. Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol. 1984 Apr;102(4):520–526. doi: 10.1001/archopht.1984.01040030398010. [DOI] [PubMed] [Google Scholar]
  25. Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984 Apr;102(4):527–532. doi: 10.1001/archopht.1984.01040030405011. [DOI] [PubMed] [Google Scholar]
  26. Klein R., Moss S. E., Klein B. E. New management concepts for timely diagnosis of diabetic retinopathy treatable by photocoagulation. Diabetes Care. 1987 Sep-Oct;10(5):633–638. doi: 10.2337/diacare.10.5.633. [DOI] [PubMed] [Google Scholar]
  27. Koplan J. P., Gutzwiller F. F. Some observations on the assessment of preventive technologies. Int J Technol Assess Health Care. 1991;7(3):361–364. doi: 10.1017/s0266462300005730. [DOI] [PubMed] [Google Scholar]
  28. Miller A. B., Baines C. J., To T., Wall C. Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years. CMAJ. 1992 Nov 15;147(10):1459–1476. [PMC free article] [PubMed] [Google Scholar]
  29. Miller A. B., Baines C. J., To T., Wall C. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ. 1992 Nov 15;147(10):1477–1488. [PMC free article] [PubMed] [Google Scholar]
  30. Roper W. L., Winkenwerder W., Hackbarth G. M., Krakauer H. Effectiveness in health care. An initiative to evaluate and improve medical practice. N Engl J Med. 1988 Nov 3;319(18):1197–1202. doi: 10.1056/NEJM198811033191805. [DOI] [PubMed] [Google Scholar]
  31. Sencer D. J., Dull H. B., Langmuir A. D. Epidemiologic basis for eradication of measles in 1967. Public Health Rep. 1967 Mar;82(3):253–256. [PMC free article] [PubMed] [Google Scholar]
  32. Stewart A. L., Greenfield S., Hays R. D., Wells K., Rogers W. H., Berry S. D., McGlynn E. A., Ware J. E., Jr Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA. 1989 Aug 18;262(7):907–913. [PubMed] [Google Scholar]
  33. Sussman E. J., Tsiaras W. G., Soper K. A. Diagnosis of diabetic eye disease. JAMA. 1982 Jun 18;247(23):3231–3234. [PubMed] [Google Scholar]
  34. Thacker S. B., Berkelman R. L. Public health surveillance in the United States. Epidemiol Rev. 1988;10:164–190. doi: 10.1093/oxfordjournals.epirev.a036021. [DOI] [PubMed] [Google Scholar]
  35. Thacker S. B., Berkelman R. L. Surveillance of medical technologies. J Public Health Policy. 1986 Autumn;7(3):363–377. [PubMed] [Google Scholar]
  36. Walter H. J. Primary prevention of chronic disease among children: the school-based "Know Your Body" intervention trials. Health Educ Q. 1989 Summer;16(2):201–214. doi: 10.1177/109019818901600205. [DOI] [PubMed] [Google Scholar]
  37. Walter H. J., Wynder E. L. The development, implementation, evaluation, and future directions of a chronic disease prevention program for children: the "Know Your Body" studies. Prev Med. 1989 Jan;18(1):59–71. doi: 10.1016/0091-7435(89)90054-6. [DOI] [PubMed] [Google Scholar]
  38. White C. C., Koplan J. P., Orenstein W. A. Benefits, risks and costs of immunization for measles, mumps and rubella. Am J Public Health. 1985 Jul;75(7):739–744. doi: 10.2105/ajph.75.7.739. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Witte J. J., Axnick N. W. The benefits from 10 years of measles immunization in the United States. Public Health Rep. 1975 May-Jun;90(3):205–207. [PMC free article] [PubMed] [Google Scholar]
  40. van der Maas P. J., de Koning H. J., van Ineveld B. M., van Oortmarssen G. J., Habbema J. D., Lubbe K. T., Geerts A. T., Collette H. J., Verbeek A. L., Hendriks J. H. The cost-effectiveness of breast cancer screening. Int J Cancer. 1989 Jun 15;43(6):1055–1060. doi: 10.1002/ijc.2910430617. [DOI] [PubMed] [Google Scholar]

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