H. Krueger & Associates Inc., Delta, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, Canada.
BMC Health Serv Res. 2022 Apr 26;22(1):564. doi: 10.1186/s12913-022-07871-0.
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.
尽管在评价临床预防服务证据方面有着长期的经验，但在加拿大和其他地方，有效的临床预防服务的提供情况并不理想。我们概述了不列颠哥伦比亚省用于协助确定哪些有效的临床预防服务值得实施的方法。
我们计算了加拿大预防保健工作组推荐的 28 项临床预防服务或美国预防服务工作组给予“A”或“B”评级的临床预防服务的可预防临床负担和成本效益。可预防临床负担是指如果按照推荐的间隔向不列颠哥伦比亚省的 40,000 名个体提供临床预防服务，可获得的总质量调整生命年数。成本效益是指每获得一个质量调整生命年数的净成本。
具有最高人群影响和最佳性价比的临床预防服务包括针对青少年和成年人吸烟、纯母乳喂养、高血压和其他心血管疾病风险因素筛查以及随后进行适当药物治疗的服务。此外，酒精滥用筛查和简短咨询、对在 1945 年至 1965 年间出生的不列颠哥伦比亚省成年人进行一次性丙型肝炎病毒感染筛查以及对 2 型糖尿病进行筛查也接近这些高价值的临床预防服务。
这些结果使政策制定者能够有一定把握地说出哪些预防措施值得实施，但还需要进一步工作来确定向所有符合条件的人提供这些服务的最佳方式，并确定所需的支持服务。毕竟，如果一项临床预防服务值得实施，就值得做好。
