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

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

ORIGINAL RESEARCH — Volume 16 — July 3, 2019

Benjamin Yarnoff, PhD1; Christina Bradley, MA1; Amanda A. Honeycutt, PhD1; Robin E. Soler, PhD2; Diane Orenstein, PhD2 (View author affiliations)

Suggested citation for this article: Yarnoff B, Bradley C, Honeycutt AA, Soler RE, Orenstein D. Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program. Prev Chronic Dis 2019;16:180594. DOI: http://dx.doi.org/10.5888/pcd16.180594external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Summary

What is already known on this topic?

Previous work demonstrated the potential long-term impact of clinical and community interventions to prevent chronic disease. However, that work considered only hypothetical interventions that may not accurately reflect the feasibility of implementation in a real-world setting.

What is added by this report?

We examined the potential 10- and 25-year impact of clinical and community interventions to prevent chronic disease as they were implemented under the Community Transformation Grant program.

What are the implications for public health practice?

Results support public health practitioners in strategic planning for chronic disease prevention.

Abstract

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.