Revisiting rose: comparing the benefits and costs of population-wide and targeted interventions.

The Milbank Quarterly
Jennifer AhernSandro Galea

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

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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
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 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
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

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