Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program

• Published in: Preventing chronic disease 2019-07, Vol.16, p.E87-E87, Article 180594
• Main Authors: Yarnoff, Benjamin, Bradley, Christina, Honeycutt, Amanda A, Soler, Robin E, Orenstein, Diane
• Format: Article
• Language: English
• Subjects: Cardiovascular Diseases - prevention & control; Community Health Services; Computer Simulation; Cost-Benefit Analysis; Environment Design; Health Planning Support; Health Promotion; Humans; Models, Biological; Original Research; Outcome Assessment, Health Care; Program Evaluation
• ISSN: 1545-1151; 1545-1151
• DOI: 10.5888/pcd16.180594

Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people's health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees. We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods. Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively. Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.