标题：Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program
摘要：Introduction
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.
Methods
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.
Results
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.
Conclusion
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.
