title: Cost-effectiveness of the 2014 U.S. Preventive Services Task Force (USPSTF) Recommendations for Intensive Behavioral Counseling Interventions for Adults With Cardiovascular Risk Factors.
abstract: In 2014, the U.S. Preventive Services Task Force (USPSTF) recommended behavioral counseling interventions for overweight or obese adults with the following known cardiovascular disease risk factors: impaired fasting glucose (IFG), hypertension, dyslipidemia, or metabolic syndrome. We assessed the long-term cost-effectiveness (CE) of implementing the recommended interventions in the U.S.
  
  
  
  We used a disease progression model to simulate the 25-year CE of the USPSTF recommendation for eligible U.S. adults and subgroups defined by a combination of the risk factors. The baseline population was estimated using 2005-2012 National Health and Nutrition Examination Survey (NHANES). The cost and effectiveness of the intervention were obtained from systematic reviews. Incremental CE ratios (ICERs), measured in cost/quality-adjusted life-year (QALY), were used to assess the CE of the intervention compared with no intervention. Future QALYs and costs (reported in 2014 U.S. dollars) were discounted at 3%.
  
  
  
  We estimated that ∼98 million U.S. adults (44%) would be eligible for the recommended intervention. Compared with no intervention, the ICER of the intervention would be $13,900/QALY. CE varied widely among subgroups, ranging from a cost saving of $302 per capita for those who were obese with IFG, hypertension, and dyslipidemia to a cost of $103,200/QALY in overweight people without these conditions.
  
  
  
  The recommended intervention is cost effective based on the conventional CE threshold. Considerable variation in CE across the recommended subpopulations suggests that prioritization based on risk level would yield larger total health gains per dollar spent.
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA xhi6@cdc.gov.
authors.forename: Ji
authors.identifier: 0000-0001-7481-3221
authors.initials: J
authors.lastname: Lin
authors.affiliation: Merck Research Laboratory, North Wales, PA.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zhuo
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.|Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bardenheier
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Rolka
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: W Edward
authors.initials: WE
authors.lastname: Gregg
authors.affiliation: Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Yuling
authors.initials: Y
authors.lastname: Hong
authors.affiliation: Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Guijing
authors.initials: G
authors.lastname: Wang
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Ann
authors.initials: A
authors.lastname: Albright
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000191:economics*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D019983:Guideline Adherence / Q000191:economics*; D006801:Humans; D009749:Nutrition Surveys; D009765:Obesity / Q000628:therapy*; D050177:Overweight / Q000628:therapy*; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D012307:Risk Factors