Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-30 (of 36 Records) |
Query Trace: Chattopadhyay SK [original query] |
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Breast and cervical cancer screenings: A systematic economic review of patient navigation services
Chattopadhyay SK , Pillai A , Reynolds J , Jacob V , Ekwueme D , Peng Y , Cuellar AE . Am J Prev Med 2024 INTRODUCTION: This paper examined the economic evidence of patient navigation services to increase breast and cervical cancer screenings among historically disadvantaged racial and ethnic populations and people with lower incomes. METHODS: The literature search strategy for this systematic review included English-language studies conducted in high-income countries that were published from database inception to December 2022. Studies on patients with existing cancer or without healthcare system involvement were excluded. Analysis was completed in January 2023. All monetary values reported are in 2022 U.S. dollars. RESULTS: The search yielded 3 breast cancer, 2 cervical cancer, and 2 multiple cancer studies that combined breast and cervical cancer with other cancer screenings. For breast cancer screening, the intervention cost per patient ranged from $109 to $10,245. Two studies reported $154 and $740 as intervention cost per additional person screened. Changes in healthcare cost per person from 2 studies were $202 and $2,437. Two studies reported cost per quality-adjusted life year (QALY) gained of $3,852 and $39,159 while one study reported cost per life year (LY) gained of $22,889. For cervical cancer, two studies reported intervention cost per person ($103 and $794) and per additional person screened ($56 and $533) with one study reporting a cost per QALY gained ($924). DISCUSSION: All estimates of cost per QALY/LY saved for breast cancer screening were below a conservative threshold of $50,000 indicating that patient navigation services for breast cancer screening were cost-effective. There is limited evidence to determine cost-effectiveness of patient navigation services for cervical cancer screening. |
Parks, trails, and greenways for physical activity: A Community Guide systematic economic review
Jacob V , Reynolds JA , Chattopadhyay SK , Hopkins DP , Brown DR , Devlin HM , Barrett A , Berrigan D , Crespo CJ , Heath GW , Brownson RC , Cuellar AE , Clymer JM , Chriqui JF . Am J Prev Med 2024 INTRODUCTION: This systematic economic review examined the cost-benefit and cost-effectiveness of park, trail, and greenway infrastructure interventions to increase physical activity or infrastructure use. METHODS: The search period covered the date of inception of publications databases through February 2022. Inclusion was limited to studies that reported cost-benefit or cost-effectiveness outcomes and were based in the United States and other high-income countries. Analyses were conducted during March 2022 through December 2022. All monetary values reported are in 2021 U.S. dollars. RESULTS: The search yielded 1 study based in the United States and 7 based on other high-income countries, with 1 reporting cost-effectiveness and 7 reporting cost-benefit outcomes. The cost-effectiveness study based in the United Kingdom reported $23,254 per disability-adjusted life year averted. The median benefit to cost ratio was 3.1 (Interquartile Interval: 2.9 to 3.9) based on 7 studies. DISCUSSION: The evidence shows that economic benefits exceed the intervention cost of park, trail, and greenway infrastructure. Given large differences in the size of infrastructure, intervention cost and economic benefits varied substantially across studies. There was insufficient number of studies to determine cost-effectiveness of these interventions. |
Economics of team-based care for blood pressure control: Updated Community Guide Systematic Review
Jacob V , Reynolds JA , Chattopadhyay SK , Nowak K , Hopkins DP , Fulmer E , Bhatt AN , Therrien NL , Cuellar AE , Kottke TE , Clymer JM , Rask KJ . Am J Prev Med 2023 65 (4) 735-754 INTRODUCTION: This paper examined the recent evidence from economic evaluations of team-based care for controlling high blood pressure. METHODS: The search covered studies published from January 2011 through January 2021 and was limited to those based in the United States (U.S.) and other high-income countries. This yielded 35 studies, 23 based in the U.S. and 12 in other high-income countries. Analyses were conducted during May 2021 through February 2023. All monetary values reported are in 2020 U.S. dollars. RESULTS: The median intervention cost per patient per year was $438 for U.S. studies and $299 for all studies. The median change in healthcare cost per patient per year following the intervention was -$140 for both U.S. studies and for all studies. The median net cost per patient per year was $439 for U.S. studies and $133 for all studies. Median cost per quality adjusted life year gained was $12,897 for U.S. studies and $15,202 for all studies, which are below a conservative benchmark of $50,000 for cost-effectiveness. DISCUSSION: Intervention cost and net cost were higher in the U.S. compared to other high- income countries. Healthcare cost averted did not exceed intervention cost in most studies. The evidence shows team-based care for blood pressure control is cost-effective, re-affirming the favorable cost-effectiveness conclusion reached in the 2015 systematic review. |
Community Guide methods for systematic reviews of economic evidence
Chattopadhyay SK , Jacob V , Hopkins DP , Lansky A , Elder R , Cuellar AE , Calonge N , Clymer JM . Am J Prev Med 2022 INTRODUCTION: Community Guide systematic economic reviews provide information on the cost, economic benefit, cost-benefit, and cost-effectiveness of public health interventions recommended by the Community Preventive Services Task Force on the basis of evidence of effectiveness. The number and variety of economic evaluation studies in public health have grown substantially over time, contributing to methodologic challenges that required updates to the methods for Community Guide systematic economic reviews. This paper describes these updated methods. METHODS: The 9-step Community Guide economic review process includes prioritization of topic, creation of a coordination team, conceptualization of review, literature search, screening studies for inclusion, abstraction of studies, analysis of results, translation of evidence to Community Preventive Services Task Force economic findings, and dissemination of findings and evidence gaps. The methods applied in each of these steps are reported in this paper. RESULTS: Two published Community Guide reviews, tailored pharmacy-based interventions to improve adherence to medications for cardiovascular disease and permanent supportive housing with housing first to prevent homelessness, are used to illustrate the application of the updated methods. The Community Preventive Services Task Force reached a finding of cost-effectiveness for the first intervention and a finding of favorable cost-benefit for the second on the basis of results from the economic reviews. CONCLUSIONS: The updated Community Guide economic systematic review methods provide transparency and improve the reliability of estimates that are used to derive a Community Preventive Services Task Force economic finding. This may in turn augment the utility of Community Guide economic reviews for communities making decisions about allocating limited resources to effective programs. |
Pharmacist Interventions for Medication Adherence: Community Guide Economic Reviews for Cardiovascular Disease
Jacob V , Reynolds JA , Chattopadhyay SK , Hopkins DP , Therrien NL , Jones CD , Durthaler JM , Rask KJ , Cuellar AE , Clymer JM , Kottke TE . Am J Prev Med 2021 62 (3) e202-e222 INTRODUCTION: Adherence to medications for cardiovascular disease and its risk factors is less than optimal, although greater adherence to medication has been shown to reduce the risk factors for cardiovascular disease. This paper examines the economics of tailored pharmacy interventions to improve medication adherence for cardiovascular disease prevention and management. METHODS: Literature from inception of databases to May 2019 was searched, yielding 29 studies for cardiovascular disease prevention and 9 studies for cardiovascular disease management. Analyses were done from June 2019 through May 2020. All monetary values are in 2019 U.S. dollars. RESULTS: The median intervention cost per patient per year was $246 for cardiovascular disease prevention and $292 for cardiovascular disease management. The median change in healthcare cost per person per year due to the intervention was -$355 for cardiovascular disease prevention and -$2,430 for cardiovascular disease management. The median total cost per person per year was -$89 for cardiovascular disease prevention, with a median return on investment of 0.01. The median total cost per person per year for cardiovascular disease management was -$1,080, with a median return on investment of 7.52, and 6 of 7 estimates indicating reduced healthcare cost averted exceeded intervention cost. For cardiovascular disease prevention, the median cost per quality-adjusted life year gained was $11,298. There were no cost effectiveness studies for cardiovascular disease management. DISCUSSION: The evidence shows that tailored pharmacy-based interventions to improve medication adherence are cost effective for cardiovascular disease prevention. For cardiovascular disease management, healthcare cost averted exceeds the cost of implementation for a favorable return on investment from a healthcare systems perspective. |
Permanent Supportive Housing With Housing First: Findings From a Community Guide Systematic Economic Review
Jacob V , Chattopadhyay SK , Attipoe-Dorcoo S , Peng Y , Hahn RA , Finnie R , Cobb J , Cuellar AE , Emmons KM , Remington PL . Am J Prev Med 2021 62 (3) e188-e201 INTRODUCTION: The annual economic burden of chronic homelessness in the U.S. is estimated to be as high as $3.4 billion. The Permanent Supportive Housing with Housing First (Housing First) program, implemented to address the problem, has been shown to be effective. This paper examines the economic cost and benefit of Housing First Programs. METHODS: The search of peer-reviewed and gray literature from inception of databases through November 2019 yielded 20 evaluation studies of Housing First Programs, 17 from the U.S. and 3 from Canada. All analyses were conducted from March 2019 through July 2020. Monetary values are reported in 2019 U.S. dollars. RESULTS: Evidence from studies conducted in the U.S. was separated from those conducted in Canada. The median intervention cost per person per year for U.S. studies was $16,479, and for all studies, including those from Canada, it was $16,336. The median total benefit for the U.S. studies was $18,247 per person per year, and it was $17,751 for all studies, including those from Canada. The benefit-to-cost ratio for U.S. studies was 1.80:1, and for all studies, including those from Canada, it was 1.06:1. DISCUSSION: The evidence from this review shows that economic benefits exceed the cost of Housing First Programs in the U.S. There were too few studies to determine cost-benefit in the Canadian context. |
Economics of interventions to increase active travel to school: A Community Guide Systematic Review
Jacob V , Chattopadhyay SK , Reynolds JA , Hopkins DP , Morgan JA , Brown DR , Kochtitzky CS , Cuellar AE , Kumanyika SK . Am J Prev Med 2021 60 (1) e27-e40 CONTEXT: The number of children who bicycle or walk to school has steadily declined in the U.S. and other high-income countries. In response, several countries responded in recent years by funding infrastructure and noninfrastructure programs that improve the safety, convenience, and attractiveness of active travel to school. The objective of this study is to synthesize the economic evidence for the cost and benefit of these programs. EVIDENCE ACQUISITION: Literature from the inception of databases to July 2018 were searched, yielding 9 economic evaluation studies. All analyses were done in September 2018-May 2019. EVIDENCE SYNTHESIS: All the studies reported cost, 6 studies reported cost benefit, and 2 studies reported cost effectiveness. The cost-effectiveness estimates were excluded on the basis of quality assessment. Cost of interventions ranged widely, with higher cost reported for the infrastructure-heavy projects from the U.S. ($91,000-$179,000 per school) and United Kingdom ($227,000-$665,000 per project). Estimates of benefits differed in the inclusion of improved safety for bicyclists and pedestrians, improved health from increased physical activity, and reduced environmental impacts due to less automobile use. The evaluations in the U.S. focused primarily on safety. The overall median benefit‒cost ratio was 4.4:1.0 (IQR=2.2:1-6.0:1, 6 studies). The 2-year benefit-cost ratios for U.S. projects in California and New York City were 1.46:1 and 1.79:1, respectively. CONCLUSIONS: The evidence indicates that interventions that improve infrastructure and enhance the safety and ease of active travel to schools generate societal economic benefits that exceed the societal cost. |
Engaging community health workers to increase cancer screening: A Community Guide Systematic Economic Review
Attipoe-Dorcoo S , Chattopadhyay SK , Verughese J , Ekwueme DU , Sabatino SA , Peng Y . Am J Prev Med 2020 60 (4) e189-e197 CONTEXT: The Community Preventive Services Task Force recommends engaging community health workers to increase breast, cervical, and colorectal cancer screenings on the basis of strong evidence of effectiveness. This systematic review examines the economic evidence of these interventions. EVIDENCE ACQUISITION: A systematic literature search was performed with a search period through April 2019 to identify relevant economic evaluation studies. All monetary values were adjusted to 2018 U.S. dollars, and the analysis was completed in 2019. EVIDENCE SYNTHESIS: A total of 19 studies were included in the final analysis with 3 on breast cancer, 5 on cervical cancer, 9 on colorectal cancer, and 2 that combined costs for breast and cervical cancers and for breast, cervical, and colorectal cancers. For cervical cancer screening, 2 U.S. studies reported incremental cost per quality-adjusted life year saved of $762 and $34,405. For colorectal cancer screening, 2 U.S. studies reported both a negative incremental cost and an increase in quality-adjusted life years saved with colonoscopy screening. CONCLUSIONS: Engaging community health workers to increase cervical and colorectal cancer screenings is cost effective on the basis of estimated incremental cost-effectiveness ratios that were less than the conservative $50,000 per quality-adjusted life year threshold. In addition, quality-adjusted life years saved from colorectal screening with colonoscopy were associated with net healthcare cost savings. |
Linking studies to assess the life expectancy associated with eighth grade school achievement
Hahn RA , Chattopadhyay SK . Prev Med Rep 2019 16 100980 Extensive evidence indicates the causal association of school outcomes and long-term health. We combined the findings of two studies by Chetty and colleagues to estimate the life expectancy associated with achievement scores in the eighth grade. We linked the dependent variable of the first study and the independent variable of the second study. The first study (of students in Tennessee) found a positive correlation between school achievement scores in eighth grade and income at age 25-27. Controlling for family background, a one percentile increase in eighth grade test score was associated with an increase of $148 (95% CI: $125, $172) in 2009 $U.S. in mean yearly wages at ages 25-27years. Based on estimated mean annual income growth of 3.35%, $148 would increase 1.59 fold to $235 (CI: $199, $273) in 14years, at age 40-$251 (CI: $213, $292) in 2012 $U.S. adjusted for inflation. The second study (of the U.S. population) found that a one percentile household income ($1500 in 2012 $U.S.) was associated with one month life expectancy at age 40. We calculate that an increase in income at age 40 attributable to one percentile increase in eighth grade test scores, i.e., $251, would increase life expectancy by 17% (i.e., $251/$1500) (CI: 14%, 19%) of one month per percentile eighth grade test score. Estimates of long-term health outcomes associated with educational outcomes can be made with caution. Applicability of findings from the Tennessee to the U.S. population is discussed. |
Economics of multicomponent interventions to increase breast, cervical, and colorectal cancer screening: A Community Guide Systematic Review
Mohan G , Chattopadhyay SK , Ekwueme DU , Sabatino SA , Okasako-Schmucker DL , Peng Y , Mercer SL , Thota AB . Am J Prev Med 2019 57 (4) 557-567 CONTEXT: The Community Preventive Services Task Force recently recommended multicomponent interventions to increase breast, cervical, and colorectal cancer screening based on strong evidence of effectiveness. This systematic review examines the economic evidence to guide decisions on the implementation of these interventions. EVIDENCE ACQUISITION: A systematic literature search for economic evidence was performed from January 2004 to January 2018. All monetary values were reported in 2016 US dollars, and the analysis was completed in 2018. EVIDENCE SYNTHESIS: Fifty-three studies were included in the body of evidence from a literature search yield of 8,568 total articles. For multicomponent interventions to increase breast cancer screening, the median intervention cost per participant was $26.69 (interquartile interval [IQI]=$3.25, $113.72), and the median incremental cost per additional woman screened was $147.64 (IQI=$32.92, $924.98). For cervical cancer screening, the median costs per participant and per additional woman screened were $159.80 (IQI=$117.62, $214.73) and $159.49 (IQI=$64.74, $331.46), respectively. Two studies reported incremental cost per quality-adjusted life year gained of $748 and $33,433. For colorectal cancer screening, the median costs per participant and per additional person screened were $36.63 (IQI=$7.70, $139.23) and $582.44 (IQI=$91.10, $1,452.12), respectively. Two studies indicated a decline in incremental cost per quality-adjusted life year gained of $1,651 and $3,817. CONCLUSIONS: Multicomponent interventions to increase cervical and colorectal cancer screening were cost effective based on a very conservative threshold. Additionally, multicomponent interventions for colorectal cancer screening demonstrated net cost savings. Cost effectiveness for multicomponent interventions to increase breast cancer screening could not be determined owing to the lack of studies reporting incremental cost per quality-adjusted life year gained. Future studies estimating this outcome could assist implementers with decision making. |
Economics of community health workers for chronic disease: Findings from Community Guide Systematic Reviews
Jacob V , Chattopadhyay SK , Hopkins DP , Reynolds JA , Xiong KZ , Jones CD , Rodriguez BJ , Proia KK , Pronk NP , Clymer JM , Goetzel RZ . Am J Prev Med 2019 56 (3) e95-e106 Context: Cardiovascular disease in the U.S. accounted for healthcare cost and productivity losses of $330 billion in 2013–2014 and diabetes accounted for $327 billion in 2017. The impact is disproportionate on minority and low-SES populations. This paper examines the available evidence on cost, economic benefit, and cost effectiveness of interventions that engage community health workers to prevent cardiovascular disease, prevent type 2 diabetes, and manage type 2 diabetes. Evidence acquisition: Literature from the inception of databases through July 2016 was searched for studies with economic information, yielding nine studies in cardiovascular disease prevention, seven studies in type 2 diabetes prevention, and 13 studies in type 2 diabetes management. Analyses were done in 2017. Monetary values are reported in 2016 U.S. dollars. Evidence synthesis: The median intervention cost per patient per year was $329 for cardiovascular disease prevention, $600 for type 2 diabetes prevention, and $571 for type 2 diabetes management. The median change in healthcare cost per patient per year was –$82 for cardiovascular disease prevention and –$72 for type 2 diabetes management. For type 2 diabetes prevention, one study saw no change and another reported –$1,242 for healthcare cost. One study reported a favorable 1.8 return on investment from engaging community health workers for cardiovascular disease prevention. Median cost per quality-adjusted life year gained was $17,670 for cardiovascular disease prevention, $17,138 (mean) for type 2 diabetes prevention, and $35,837 for type 2 diabetes management. Conclusions: Interventions engaging community health workers are cost effective for cardiovascular disease prevention and type 2 diabetes management, based on a conservative $50,000 benchmark for cost per quality-adjusted life year gained. Two cost per quality-adjusted life year estimates for type 2 diabetes prevention were far below the $50,000 benchmark. |
Community Guide Cardiovascular Disease Economic Reviews: Tailoring methods to ensure utility of findings
Chattopadhyay SK , Jacob V , Mercer SL , Hopkins DP , Elder RW , Jones CD . Am J Prev Med 2017 53 S155-s163 The Community Preventive Services Task Force recommended five interventions for cardiovascular disease prevention between 2012 and 2015. Systematic economic reviews of these interventions faced challenges that made it difficult to generate meaningful policy and programmatic conclusions. This paper describes the methods used to assess, synthesize, and evaluate the economic evidence to generate reliable and useful economic conclusions and address the comparability of economic findings across interventions. Specifically, steps were taken to assess completeness of data and identify the components and drivers of cost and benefit. Except for the intervention cost of self-measured blood pressure monitoring intervention, either alone or with patient support, all cost and benefit estimates were standardized as per patient per year. When possible, intermediate outcomes were converted to quality-adjusted life year. Differences within and between interventions were considered to generate economic conclusions and inform their comparability. The literature search period varied among interventions. This analysis was completed in 2016. Although team-based care, self-measured blood pressure monitoring with patient support, and self-measured blood pressure monitoring within team-based care were found to be cost effective, their cost-effectiveness estimates were not comparable because of differences in the intervention characteristics. Lack of enough data or incomplete information made it difficult to reach an overall economic finding for the other interventions. The Community Guide methods discussed here may help others conducting systematic economic reviews of public health interventions to respond to challenges with the synthesis of evidence and provide useful findings for public health decision makers. |
Economics of self-measured blood pressure monitoring: A Community Guide Systematic Review
Jacob V , Chattopadhyay SK , Proia KK , Hopkins DP , Reynolds J , Thota AB , Jones CD , Lackland DT , Rask KJ , Pronk NP , Clymer JM , Goetzel RZ . Am J Prev Med 2017 53 (3) e105-e113 CONTEXT: The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of self-measured blood pressure (SMBP) monitoring interventions to control hypertension. EVIDENCE ACQUISITION: The literature search from database inception to March 2015 identified 22 studies for inclusion with three types of interventions: SMBP used alone, SMBP with additional support, and SMBP within team-based care (TBC). Two formulae were used to convert reductions in systolic BP (SBP) to quality-adjusted life years (QALYs) to produce cost per QALY saved. All analyses were conducted in 2015, with estimates adjusted to 2014 U.S. dollars. EVIDENCE SYNTHESIS: Median costs of intervention were $60 and $174 per person for SMBP alone and SMBP with additional support, respectively, and $732 per person per year for SMBP within TBC. SMBP alone and SMBP with additional support reduced healthcare cost per person per year from outpatient visits and medication (medians $148 and $3, respectively; median follow-up, 12-13 months). SMBP within TBC exhibited an increase in healthcare cost (median, $369 per person per year; median follow-up, 18 months). SMBP alone varied from cost saving to a maximum cost of $144,000 per QALY saved, with two studies reporting an increase in SBP. The two translated median costs per QALY saved were $2,800 and $4,000 for SMBP with additional support and $7,500 and $10,800 for SMBP within TBC. CONCLUSIONS: SMBP monitoring interventions with additional support or within TBC are cost effective. Cost effectiveness of SMBP used alone could not be determined. |
Early childhood education to promote health equity: A Community Guide economic review
Ramon I , Chattopadhyay SK , Barnett WS , Hahn RA . J Public Health Manag Pract 2017 24 (1) e8-e15 CONTEXT: A recent Community Guide systematic review found that early childhood education (ECE) programs improve educational, social, and health-related outcomes and advance health equity because many are designed to increase enrollment for high-risk children. This follow-up economic review examines how the economic benefits of center-based ECE programs compare with their costs. EVIDENCE ACQUISITION: Kay and Pennucci from the Washington State Institute for Public Policy, whose meta-analysis formed the basis of the Community Guide effectiveness review, conducted a benefit-cost analysis of ECE programs for low-income children in Washington State. We performed an electronic database search using both effectiveness and economic key words to identify additional cost-benefit studies published through May 2015. Kay and Pennucci also provided us with national-level benefit-cost estimates for state and district and federal Head Start programs. EVIDENCE SYNTHESIS: The median benefit-to-cost ratio from 11 estimates of earnings gains, the major benefit driver for 3 types of ECE programs (ie, state and district, federal Head Start, and model programs), was 3.39:1 (interquartile interval [IQI] = 2.48-4.39). The overall median benefit-to-cost ratio from 7 estimates of total benefits, based on all benefit components including earnings gains, was 4.19:1 (IQI = 2.62-8.60), indicating that for every dollar invested in the program, there was a return of $4.19 in total benefits. CONCLUSIONS: ECE programs promote both equity and economic efficiency. Evidence indicates there is positive social return on investment in ECE irrespective of the type of ECE program. The adoption of a societal perspective is crucial to understand all costs and benefits of ECE programs regardless of who pays for the costs or receives the benefits. |
Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a Community Guide systematic review
Jacob V , Thota AB , Chattopadhyay SK , Njie GJ , Proia KK , Hopkins DP , Ross MN , Pronk NP , Clymer JM . J Am Med Inform Assoc 2017 24 (3) 669-676 OBJECTIVE: This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSSs) to prevent cardiovascular disease (CVD). MATERIALS AND METHODS: Methods developed for the Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion. RESULTS: It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSSs to prevent CVD from the available studies (n = 12) due to considerable heterogeneity. Several studies (n = 11) indicated that health care costs were averted by using CDSSs but many were partial assessments that did not consider all components of health care. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSSs based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold. DISCUSSION: Intervention costs were not negligible, but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted health care cost could not be determined with confidence because many studies did not fully account for all components of health care. CONCLUSION: We were unable to conclude whether CDSSs for CVD prevention is either cost-beneficial or cost-effective. Several evidence gaps are identified, most prominently a lack of information about major drivers of cost and benefit, a lack of standard metrics for the cost of CDSSs, and not allowing for useful life of a CDSS that generally extends beyond one accounting period. |
Alcohol electronic screening and brief intervention: A Community Guide systematic review
Tansil KA , Esser MB , Sandhu P , Reynolds JA , Elder RW , Williamson RS , Chattopadhyay SK , Bohm MK , Brewer RD , McKnight-Eily LR , Hungerford DW , Toomey TL , Hingson RW , Fielding JE . Am J Prev Med 2016 51 (5) 801-811 CONTEXT: Excessive drinking is responsible for one in ten deaths among working-age adults in the U.S. annually. Alcohol screening and brief intervention is an effective but underutilized intervention for reducing excessive drinking among adults. Electronic screening and brief intervention (e-SBI) uses electronic devices to deliver key elements of alcohol screening and brief intervention, with the potential to expand population reach. EVIDENCE ACQUISITION: Using Community Guide methods, a systematic review of the scientific literature on the effectiveness of e-SBI for reducing excessive alcohol consumption and related harms was conducted. The search covered studies published from 1967 to October 2011. A total of 31 studies with 36 study arms met quality criteria and were included in the review. Analyses were conducted in 2012. EVIDENCE SYNTHESIS: Twenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months. CONCLUSIONS: According to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density). |
Economic evaluation of school-based health centers: A Community Guide systematic review
Ran T , Chattopadhyay SK , Hahn RA . Am J Prev Med 2016 51 (1) 129-38 CONTEXT: A recent Community Guide systematic review of effectiveness of school-based health centers (SBHCs) showed that SBHCs improved educational and health outcomes. This review evaluates the economic cost and benefit of SBHCs. EVIDENCE ACQUISITION: Using economic systematic review methods developed for The Community Guide, 6,958 papers were identified for the search period January 1985 to September 2014. After two rounds of screening, 21 studies were included in this review: 15 studies reported on cost and nine on benefit; three studies had both cost and benefit information. All expenditures in this review were presented in 2013 U.S. dollars. EVIDENCE SYNTHESIS: Analyses were conducted in 2014. Intervention cost had two main components: start-up cost and operating cost. All but two of the cost studies reported operating cost only (ranging from $16,322 to $659,684 per SBHC annually). Benefits included healthcare cost averted and productivity and other loss averted. From the societal perspective, total annual benefit per SBHC ranged from $15,028 to $912,878. From healthcare payers' perspective, particularly Medicaid, SBHCs led to net savings ranging from $30 to $969 per visit. From patients' perspective, savings were also positive. Additionally, two benefit studies used regression analysis to show that Medicaid cost and hospitalization cost decreased with SBHCs. Finally, results from seven estimates in two cost-benefit studies showed that societal benefit per SBHC exceeded intervention cost, with the benefit-cost ratio ranging from 1.38:1 to 3.05:1. CONCLUSIONS: The economic benefit of SBHCs exceeds the intervention operating cost. Further, SBHCs result in net savings to Medicaid. |
Increasing coverage of appropriate vaccinations: a Community Guide systematic economic review
Jacob V , Chattopadhyay SK , Hopkins DP , Murphy Morgan J , Pitan AA , Clymer JM . Am J Prev Med 2016 50 (6) 797-808 CONTEXT: Population-level coverage for immunization against many vaccine-preventable diseases remains below optimal rates in the U.S. The Community Preventive Services Task Force recently recommended several interventions to increase vaccination coverage based on systematic reviews of the evaluation literature. The present study provides the economic results from those reviews. EVIDENCE ACQUISITION: A systematic review was conducted (search period, January 1980 through February 2012) to identify economic evaluations of 12 interventions recommended by the Task Force. Evidence was drawn from included studies; estimates were constructed for the population reach of each strategy, cost of implementation, and cost per additional vaccinated person because of the intervention. Analyses were conducted in 2014. EVIDENCE SYNTHESIS: Reminder systems, whether for clients or providers, were among the lowest-cost strategies to implement and the most cost effective in terms of additional people vaccinated. Strategies involving home visits and combination strategies in community settings were both costly and less cost effective. Strategies based in settings such as schools and MCOs that reached the target population achieved additional vaccinations in the middle range of cost effectiveness. CONCLUSIONS: The interventions recommended by the Task Force differed in reach, cost, and cost effectiveness. This systematic review presents the economic information for 12 effective strategies to increase vaccination coverage that can guide implementers in their choice of interventions to fit their local needs, available resources, and budget. |
Economic evaluation of community water fluoridation: A Community Guide systematic review
Ran T , Chattopadhyay SK . Am J Prev Med 2016 50 (6) 790-796 CONTEXT: A recently updated Community Guide systematic review of the effectiveness of community water fluoridation once again found evidence that it reduces dental caries. Although community water fluoridation was found to save money in a 2002 Community Guide systematic review, the conclusion was based on studies conducted before 1995. Given the update to the effectiveness review, re-examination of the benefit and cost of community water fluoridation is necessary. EVIDENCE ACQUISITION: Using methods developed for Community Guide economic reviews, 564 studies were identified within a search period from January 1995 to November 2013. Ten studies were included in the current review, with four covering community fluoridation benefits only and another six providing both cost and benefit information. Additionally, two of the six studies analyzed the cost effectiveness of community water fluoridation. All currencies were converted to 2013 dollars. EVIDENCE SYNTHESIS: The analysis was conducted in 2014. The benefit-only studies used regression analysis, showing that different measures of dental costs were always lower in communities with water fluoridation. For the six cost-benefit studies, per capita annual intervention cost ranged from $0.11 to $4.92 for communities with at least 1,000 population, and per capita annual benefit ranged from $5.49 to $93.19. Benefit-cost ratios ranged from 1.12:1 to 135:1, and these ratios were positively associated with community population size. CONCLUSIONS: Recent evidence continues to indicate that the economic benefit of community water fluoridation exceeds the intervention cost. Further, the benefit-cost ratio increases with the community population size. |
Economics of team-based care in controlling blood pressure: a Community Guide systematic review
Jacob V , Chattopadhyay SK , Thota AB , Proia KK , Njie G , Hopkins DP , Finnie RK , Pronk NP , Kottke TE . Am J Prev Med 2015 49 (5) 772-83 CONTEXT: High blood pressure is an important risk factor for cardiovascular disease and stroke, the leading cause of death in the U.S., and a substantial national burden through lost productivity and medical care. A recent Community Guide systematic review found strong evidence of effectiveness of team-based care in improving blood pressure control. The objective of the present review is to determine from the economic literature whether team-based care for blood pressure control is cost beneficial or cost effective. EVIDENCE ACQUISITION: Electronic databases of papers published January 1980-May 2012 were searched to find economic evaluations of team-based care interventions to improve blood pressure outcomes, yielding 31 studies for inclusion. EVIDENCE SYNTHESIS: In analyses conducted in 2012, intervention cost, healthcare cost averted, benefit-to-cost ratios, and cost effectiveness were abstracted from the studies. The quality of estimates for intervention and healthcare cost from each study were assessed using three elements: intervention focus on blood pressure control, incremental estimates in the intervention group relative to a control group, and inclusion of major cost-driving elements in estimates. Intervention cost per unit reduction in systolic blood pressure was converted to lifetime intervention cost per quality-adjusted life-year (QALY) saved using algorithms from published trials. CONCLUSIONS: Team-based care to improve blood pressure control is cost effective based on evidence that 26 of 28 estimates of $/QALY gained from ten studies were below a conservative threshold of $50,000. This finding is salient to recent U.S. healthcare reforms and coordinated patient-centered care through formation of Accountable Care Organizations. |
High school completion programs: a Community Guide systematic economic review
Qu S , Chattopadhyay SK , Hahn RA . J Public Health Manag Pract 2015 22 (3) E47-56 CONTEXT: On-time high school graduation rate is among the 26 leading health indicators for Healthy People 2020. High school completion (HSC) programs aim to increase the likelihood that students finish high school and receive a high school diploma or complete a GED (General Educational Development) program. This systematic review was conducted to determine the economic impact of HSC interventions, assess variability in cost-effectiveness of different types of programs, and compare the lifetime benefit of completing high school with the cost of intervention. EVIDENCE ACQUISITION: Forty-seven included studies were identified from 5303 articles published in English from January 1985 to December 2012. The economic evidence was summarized by type of HSC program. All monetary values were expressed in 2012 US dollars. The data were analyzed in 2013. EVIDENCE SYNTHESIS: Thirty-seven studies provided estimates of incremental cost per additional high school graduate, with a median cost for HSC programs of $69 800 (interquartile interval = $35 900-$130 300). Cost-effectiveness ratios varied depending on intervention type, study settings, student populations, and costing methodologies. Ten studies estimated the lifetime difference of economic benefits between high school nongraduates and graduates; 4 used a governmental perspective and reported benefit per additional high school to range from $187 000 to $240 000; 6 used a societal perspective and reported a range of $347 000 to $718 000. Benefits exceeded costs in most studies from a governmental perspective and in all studies from a societal perspective. CONCLUSION: Interventions to increase HSC rates produce substantial economic benefits to government and society including averted health care costs. From a societal perspective, the benefits also exceed costs, implying a positive rate of return from investment in HSC programs. |
Economic impact of tobacco price increases through taxation: a Community Guide systematic review
Contreary KA , Chattopadhyay SK , Hopkins DP , Chaloupka FJ , Forster JL , Grimshaw V , Holmes CB , Goetzel RZ , Fielding JE . Am J Prev Med 2015 49 (5) 800-808 CONTEXT: Tobacco use is a leading cause of preventable death in the U.S. and around the world. Increasing tobacco price through higher taxes is an effective intervention both to reduce tobacco use in the population and generate government revenues. The goal of this paper is to review evidence on the economic impact of tobacco price increases through taxation with a focus on the likely healthcare cost savings and improvements in employee productivity. EVIDENCE ACQUISITION: The search covered studies published in English from January 2000 to July 2012 and included evaluations of national, state, and local policies to increase the price of any type of tobacco product by raising taxes in high-income countries. Economic review methods developed for The Guide to Community Preventive Services were used to screen and abstract included studies. Economic impact estimates were standardized to summarize the available evidence. Analyses were conducted in 2012. EVIDENCE SYNTHESIS: The review included eight modeling studies, with seven providing estimates of the impact on healthcare costs and three providing estimates of the value of productivity gains. Only one study provided an estimate of intervention costs. The economic merit of tobacco product price increases through taxation was determined from the overall body of evidence on per capita annual cost savings from a conservative 20% price increase. CONCLUSIONS: The evidence indicates that interventions that raise the unit price of tobacco products through taxes generate substantial healthcare cost savings and can generate additional gains from improved productivity in the workplace. |
Out-of-school-time academic programs to improve school achievement: a Community Guide health equity systematic review
Knopf JA , Hahn RA , Proia KK , Truman BI , Johnson RL , Muntaner C , Fielding JE , Jones CP , Fullilove MT , Hunt PC , Qu S , Chattopadhyay SK , Milstein B . J Public Health Manag Pract 2015 21 (6) 594-608 CONTEXT: Low-income and minority status in the United States are associated with poor educational outcomes, which, in turn, reduce the long-term health benefits of education. OBJECTIVE: This systematic review assessed the extent to which out-of-school-time academic (OSTA) programs for at-risk students, most of whom are from low-income and racial/ethnic minority families, can improve academic achievement. Because most OSTA programs serve low-income and ethnic/racial minority students, programs may improve health equity. DESIGN: Methods of the Guide to Community Preventive Services were used. An existing systematic review assessing the effects of OSTA programs on academic outcomes (Lauer et al 2006; search period 1985-2003) was supplemented with a Community Guide update (search period 2003-2011). MAIN OUTCOME MEASURE: Standardized mean difference. RESULTS: Thirty-two studies from the existing review and 25 studies from the update were combined and stratified by program focus (ie, reading-focused, math-focused, general academic programs, and programs with minimal academic focus). Focused programs were more effective than general or minimal academic programs. Reading-focused programs were effective only for students in grades K-3. There was insufficient evidence to determine effectiveness on behavioral outcomes and longer-term academic outcomes. CONCLUSIONS: OSTA programs, particularly focused programs, are effective in increasing academic achievement for at-risk students. Ongoing school and social environments that support learning and development may be essential to ensure the longer-term benefits of OSTA programs. |
Economics of mass media health campaigns with health-related product distribution: a Community Guide Systematic Review
Jacob V , Chattopadhyay SK , Elder RW , Robinson MN , Tansil KA , Soler RE , Labre MP , Mercer SL . Am J Prev Med 2014 47 (3) 348-359 CONTEXT: The objective of this systematic review was to determine the costs, benefits, and overall economic value of communication campaigns that included mass media and distribution of specified health-related products at reduced price or free of charge. EVIDENCE ACQUISITION: Economic evaluation studies from a literature search from January 1980 to December 2009 were screened and abstracted following systematic economic review methods developed by The Community Guide. Data were analyzed in 2011. EVIDENCE SYNTHESIS: The economic evidence was grouped and assessed by type of product distributed and health risk addressed. A total of 15 evaluation studies were included in the economic review, involving campaigns promoting the use of child car seats or booster seats, pedometers, condoms, recreational safety helmets, and nicotine replacement therapy. CONCLUSIONS: Economic merits of the intervention could not be determined for health communication campaigns associated with use of recreational helmets, child car seats, and pedometers, primarily because available economic information and analyses were incomplete. There is some evidence that campaigns with free condom distribution to promote safer sex practices were cost-effective among high-risk populations and the cost per quit achieved in campaigns promoting tobacco cessation with nicotine replacement therapy products may translate to a cost per quality-adjusted life-year less than $50,000. Many interventions were publicly funded trials or programs, and the failure to properly evaluate their economic cost and benefit is a serious gap in the science and practice of public health. |
Publicized sobriety checkpoint programs: a Community Guide systematic review
Bergen G , Pitan A , Qu S , Shults RA , Chattopadhyay SK , Elder RW , Sleet DA , Coleman HL , Compton RP , Nichols JL , Clymer JM , Calvert WB . Am J Prev Med 2014 46 (5) 529-539 CONTEXT: Publicized sobriety checkpoint programs deter alcohol-impaired driving by stopping drivers systematically to assess their alcohol impairment. Sobriety checkpoints were recommended in 2001 by the Community Preventive Services Task Force for reducing alcohol-impaired driving, based on strong evidence of effectiveness. Since the 2001 review, attention to alcohol-impaired driving as a U.S. public health problem has decreased. This systematic review was conducted to determine if available evidence supports the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-impaired driving, given the current context. The economic costs and benefits of the intervention were also assessed. EVIDENCE ACQUISITION: This review focused on studies that evaluated the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities. Using Community Guide methods, a systematic search was conducted for studies published between July 2000 and March 2012 that assessed the effectiveness of publicized sobriety checkpoint programs. EVIDENCE SYNTHESIS: Fourteen evaluations of selective breath testing and one of random breath testing checkpoints met the inclusion criteria for the systematic review, conducted in 2012. Ten evaluations assessed the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities, finding a median reduction of 8.9% in this crash type (interquartile interval=-16.5%, -3.5%). Five economic evaluations showed benefit-cost ratios ranging from 2:1 to 57:1. CONCLUSIONS: The number of studies, magnitude of effect, and consistency of findings indicate strong evidence of the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-involved crash fatalities. Economic evidence shows that these programs also have the potential for substantial cost savings. |
Effects of full-day kindergarten on the long-term health prospects of children in low-income and racial/ethnic-minority populations: a Community Guide systematic review
Hahn RA , Rammohan V , Truman BI , Milstein B , Johnson RL , Muntaner C , Jones CP , Fullilove MT , Chattopadhyay SK , Hunt PC , Abraido-Lanza AF . Am J Prev Med 2014 46 (3) 312-23 CONTEXT: Children from low-income and minority families are often behind higher-income and majority children in language, cognitive, and social development even before they enter school. Because educational achievement has been shown to improve long-term health, addressing these delays may foster greater health equity. This systematic review assesses the extent to which full-day kindergarten (FDK), compared with half-day kindergarten (HDK), prepares children, particularly those from low-income and minority families, to succeed in primary and secondary school and improve lifelong health. EVIDENCE ACQUISITION: A meta-analysis (2010) on the effects of FDK versus HDK among U.S. children measured educational achievement at the end of kindergarten. The meta-analysis was concordant with Community Guide criteria. Findings on the longer-term effects of FDK suggested "fade-out" by third grade. The present review used evidence on the longer-term effects of pre-K education to explore the loss of FDK effects over time. EVIDENCE SYNTHESIS: FDK improved academic achievement by an average of 0.35 SDs (Cohen's d; 95% CI=0.23, 0.46). The effect on verbal achievement was 0.46 (Cohen's d; 95% CI=0.32, 0.61) and that on math achievement was 0.24 (Cohen's d; 95% CI=0.06, 0.43). Evidence of "fade-out" from pre-K education found that better-designed studies indicated both residual benefits over multiple years and the utility of educational boosters to maintain benefits, suggesting analogous longer-term effects of FDK. CONCLUSIONS: There is strong evidence that FDK improves academic achievement, a predictor of longer-term health benefits. To sustain early benefits, intensive elementary school education is needed. If targeted to low-income and minority communities, FDK can advance health equity. |
Economics of collaborative care for management of depressive disorders: a community guide systematic review
Jacob V , Chattopadhyay SK , Sipe TA , Thota AB , Byard GJ , Chapman DP . Am J Prev Med 2012 42 (5) 539-49 CONTEXT: Major depressive disorders are frequently underdiagnosed and undertreated. Collaborative Care models developed from the Chronic Care Model during the past 20 years have improved the quality of depression management in the community, raising intervention cost incrementally above usual care. This paper assesses the economic efficiency of collaborative care for management of depressive disorders by comparing its economic costs and economic benefits to usual care, as informed by a systematic review of the literature. EVIDENCE ACQUISITION: The economic review of collaborative care for management of depressive disorders was conducted in tandem with a review of effectiveness, under the guidance of the Community Preventive Services Task Force, a nonfederal, independent group of public health leaders and experts. Economic review methods developed by the Guide to Community Preventive Services were used by two economists to screen, abstract, adjust, and summarize the economic evidence of collaborative care from societal and other perspectives. An earlier economic review that included eight RCTs was included as part of the evidence. The present economic review expanded the evidence with results from studies published from 1980 to 2009 and included both RCTs and other study designs. EVIDENCE SYNTHESIS: In addition to the eight RCTs included in the earlier review, 22 more studies of collaborative care that provided estimates for economic outcomes were identified, 20 of which were evaluations of actual interventions and two of which were based on models. Of seven studies that measured only economic benefits of collaborative care in terms of averted healthcare or productivity loss, four found positive economic benefits due to intervention and three found minimal or no incremental benefit. Of five studies that measured both benefits and costs, three found lower collaborative care cost because of reduced healthcare utilization or enhanced productivity, and one found the same for a subpopulation of the intervention group. One study found that willingness to pay for collaborative care exceeded program costs. Among six cost-utility studies, five found collaborative care was cost effective. In two modeled studies, one showed cost effectiveness based on comparison of $/disability-adjusted life-year to annual per capita income; the other demonstrated cost effectiveness based on the standard threshold of $50,000/quality-adjusted life year, unadjusted for inflation. Finally, six of eight studies in the earlier review reported that interventions were cost effective on the basis of the standard threshold. CONCLUSIONS: The evidence indicates that collaborative care for management of depressive disorders provides good economic value. |
The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services
Chin HB , Sipe TA , Elder R , Mercer SL , Chattopadhyay SK , Jacob V , Wethington HR , Kirby D , Elliston DB , Griffith M , Chuke SO , Briss SC , Ericksen I , Galbraith JS , Herbst JH , Johnson RL , Kraft JM , Noar SM , Romero LM , Santelli J , Community Preventive Services Task Force . Am J Prev Med 2012 42 (3) 272-94 CONTEXT: Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group. EVIDENCE ACQUISITION: Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews. EVIDENCE SYNTHESIS: Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates. CONCLUSIONS: Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education. |
Methods for conducting community guide systematic reviews of evidence on effectiveness and economic efficiency of group-based behavioral interventions to prevent adolescent pregnancy, human immunodeficiency virus, and other sexually transmitted infections: comprehensive risk reduction and abstinence education
Sipe TA , Chin HB , Elder R , Mercer SL , Chattopadhyay SK , Jacob V , Community Preventive Services Task Force . Am J Prev Med 2012 42 (3) 295-303 This paper describes methods used to conduct systematic reviews and meta-analyses and economic reviews of group-based behavioral interventions for adolescents to prevent pregnancy, HIV, and other sexually transmitted infections. The steps described include developing a conceptual approach, defining the interventions, identifying outcome and moderator variables, searching the literature, abstracting the data, and analyzing the results. In addition, identification of potential harms and benefits, applicability of results, barriers to implementation, and research gaps are described. |
Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: two community guide systematic reviews
Rammohan V , Hahn RA , Elder R , Brewer R , Fielding J , Naimi TS , Toomey TL , Chattopadhyay SK , Zometa C . Am J Prev Med 2011 41 (3) 334-43 CONTEXT: Dram shop liability holds the owner or server(s) at a bar, restaurant, or other location where a patron, adult or underage, consumed his or her last alcoholic beverage responsible for harms subsequently inflicted by the patron on others. Liability in a state can be established by case law or statute. Overservice laws prohibit the sale of alcoholic beverages to intoxicated patrons drinking in on-premises retail alcohol outlets (i.e., premises where the alcohol is consumed where purchased); enhanced enforcement of these laws is intended to ensure compliance by premises personnel. Both of these interventions are ultimately designed to promote responsible beverage service by reducing sales to intoxicated patrons, underage youth, or both. This review assesses the effectiveness of dram shop liability and the enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. EVIDENCE ACQUISITION: Studies assessing alcohol-related harms in states adopting dram shop laws were evaluated, as were studies assessing alcohol-related harms in regions with enhanced overservice enforcement. Methods previously developed for systematic reviews for the Guide to Community Preventive Services were used. EVIDENCE SYNTHESIS: Eleven studies assessed the association of state dram shop liability with various outcomes, including all-cause motor vehicle crash deaths, alcohol-related motor vehicle crash deaths (the most common outcome assessed in the studies reviewed), alcohol consumption, and other alcohol-related harms. There was a median reduction of 6.4% (range of values 3.7% to 11.3% reduction) in alcohol-related motor vehicle fatalities associated with the presence of dram shop liability in jurisdictions where premises are licensed. Other alcohol-related outcomes also showed a reduction. Only two studies assessed the effects of enhanced enforcement initiatives on alcohol-related outcomes; findings were inconsistent, some indicating benefit and others none. CONCLUSIONS: According to Community Guide rules of evidence, the number and consistency of findings indicate strong evidence of the effectiveness of dram shop laws in reducing alcohol-related harms. It will be important to assess the possible effects of legal modifications to dram shop proceedings, such as the imposition of statutes of limitation, increased evidentiary requirements, and caps on recoverable amounts. According to Community Guide rules of evidence, evidence is insufficient to determine the effectiveness of enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. |
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