Abstract
Geoffrey Rose's two principal approaches to public health intervention are (1) targeted strategies focusing on individuals at a personal increased risk of disease and (2) population-wide approaches focusing on the whole population. Beyond his discussion of the strengths and weaknesses of these approaches, there is no empiric work examining the conditions under which one of these approaches may be better than the other. This article uses mathematical simulations to model the benefits and costs of the two approaches, varying the cut points for treatment, effect magnitudes, and costs of the interventions. These techniques then were applied to the specific example of an intervention on blood pressure to reduce cardiovascular disease. In the general simulation (using an inverse logit risk curve), lower costs of intervention, treating people with risk factor values at or above where the slope on the risk curve is at its steepest (for targeted interventions), and interventions with larger effects on reducing the risk factor (for population-wide interventions) provided benefit/cost advantages. In the specific blood pressure intervention example, lower-cost population-wide interventions had better benefit/cost ratios, but some targeted ...Continue Reading
References
Jul 1, 1976·The American Journal of Cardiology·W B KannelT Gordon
May 11, 1991·BMJ : British Medical Journal·I S KristiansenD S Thelle
Jun 26, 1991·JAMA : the Journal of the American Medical Association
Dec 1, 1995·Journal of General Internal Medicine·T W Odell, M C Gregory
Sep 1, 1996·Annals of Epidemiology·S L Syme
Apr 17, 1997·The New England Journal of Medicine·L J AppelN Karanja
Feb 17, 1998·Social Science & Medicine·C DuncanG Moon
Jun 20, 1998·American Journal of Hypertension·K A PearceJ Kirk
Jul 9, 1999·Journal of Epidemiology and Community Health·L WeinehallS Wall
Jun 21, 2001·International Journal of Epidemiology·G Rose
Jul 26, 2002·Social Science & Medicine·Sally MacintyreSteven Cummins
Mar 7, 2003·Lancet·Christopher J L MurrayDavid B Evans
Mar 28, 2003·American Journal of Public Health·Cheryl Merzel, Joanna D'Afflitti
May 16, 2003·JAMA : the Journal of the American Medical Association·Aram V ChobanianUNKNOWN National High Blood Pressure Education Program Coordinating Committee
Jul 6, 2004·Epidemiologic Reviews·Ana V Diez Roux
Dec 14, 2006·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Peter LindgrenUNKNOWN ASCOT investigators
Citations
Jul 11, 2013·Journal of Environmental and Public Health·Daniel Fuller, Patrick Morency
Aug 8, 2014·American Journal of Public Health·Magdalena CerdáSandro Galea
Aug 9, 2012·Epidemiology·David H Rehkopf
Jan 18, 2011·American Journal of Preventive Medicine·Thomas D KoepsellFrederick P Rivara
Jun 14, 2015·International Journal of Epidemiology·Arnaud ChioleroFred Paccaud
Oct 4, 2012·Community Dentistry and Oral Epidemiology·Paul Batchelor
Apr 24, 2015·American Journal of Public Health·Shilpa PatelChau Trinh-Shevrin
Apr 22, 2015·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Massimo VolpeAllegra Battistoni
Feb 11, 2015·Journal of Transport & Health·Kara E MacLeodDavid R Ragland
Apr 10, 2013·Health Affairs·Geraint LewisRhema Vaithianathan
Sep 9, 2011·Health Communication·Iccha Basnyat, Mohan Joyti Dutta
Jul 7, 2020·Psychological Medicine·Mark DeadySamuel B Harvey
Oct 30, 2018·Journal of the American Heart Association·Allan D SnidermanMichael Pencina
Aug 5, 2021·Epidemiology·Tim BrucknerBernadette Boden-Albala