Public Health 101 Series

Instructor name

Title

Organization

Introduction to Prevention 

Effectiveness

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for Disease Control and Prevention is not required, but citation of the source is 

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Course Topics

Introduction to Prevention 

Effectiveness

2 

1. A Public Health Approach

2. What Is Prevention Effectiveness?

3. Prevention Effectiveness Study Design

4. Economic Costs

5. Types of Economic Evaluations
After completing this course, you will be able to

Learning Objectives

3 

• define prevention effectiveness

• describe the key components of prevention 

effectiveness studies

• identify basic economic evaluation methods 

used in prevention effectiveness studies

• identify data used in the most common types 

of economic evaluation methods 
A Public Health Approach

Topic 1

4 
A Public Health Approach

Surveillance Risk Factor 

Identification

Intervention

Evaluation Implementation

5 
Public Health Core Sciences

6 
Topic 2

What Is Prevention Effectiveness?

7 
Prevention effectiveness is the 

systematic assessment of the 

impact of public health 

policies, programs, and 

practices on health outcomes 

by determining their 

effectiveness, safety, and 

costs. 

Prevention Effectiveness Defined

8 Haddix AC, Teutsch SM, Corso PS. Prevention effectiveness: a guide to decision analysis and economic evaluation, 2nd ed. New York, 

NY: Oxford University Press; 2002.

 
What Prevention Effectiveness Does

Centers for Disease Control and Prevention (CDC). What is prevention effectiveness? Atlanta, GA: US Department of Health and 

Human Services, CDC; 2010. http://www.cdc.gov/PEF/WhatIs.html.

Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed. 

Oxford, England: Oxford University Press; 2002: 1. 9 

Assesses

the impact

of prevention 

policies, programs, 

and practices

Evaluates

the allocation

of health care 

resources

Provides decision 

makers

with information

for action
Prevention Effectiveness in Developing 

and Implementing Prevention Strategies

Adapted from: Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 

2nd ed. Oxford, England: Oxford University Press; 2002: 2. 10

Basic

Research

Is 

prevention

plausible?

Does 

prevention 

work 

(effectiveness)?

Prevention Effectiveness

Applied

Research

Community

Demonstrations Implementation

Is it 

continuing

to work?

Can 

prevention 

work 

(efficacy)? 
Prevention effectiveness includes which of the 

following? (Select all that apply.) 

Knowledge Check

11

A. Examining costs and benefits

B. Providing funding for an intervention

C. Evaluating allocation of health care resources

D. Assessing the impact of different policies, 

programs, and practices
Prevention Effectiveness

Study Design

Topic 3

12
Prevention Effectiveness 

Design Approaches

13
Problem Identification

Any health-related situation 

in which a policy solution or 

management decision can 

be applied

Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed. Oxford, 

England: Oxford University Press; 2002. 

Centers for Disease Control and Prevention (CDC). Framing an economic evaluation [self-study course]. Atlanta, GA: US Department of 

Health and Human Services, CDC; [undated]. http://www.cdc.gov/owcd/eet/framing3/1.html. 14
• Policy and program decision 

makers 

• Health care organizations

• Researchers 

• Clinical workers

• The general public

• The media

Audience Identification

Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed. Oxford, 

England: Oxford University Press; 2002.

Centers for Disease Control. A framework for assessing the effectiveness of disease and injury prevention. MMWR Recommend Report

1992;41(No. RR-3).

15
Perspective Identification

16

Cost item Patient Physician

Payer 

(e.g., 

insurance, 

Medicaid)

Society

Physician time   

Medication   

Administration   

Patient travel  

Time off from work  
1. 

2.

3. 

Problem identification

Audience identification

Perspective identification

What are the three prevention effectiveness study 

design approaches?

Knowledge Check

17

Fill in the blanks with the correct answers. 
Economic Costs

Topic 4

18
Prevention Effectiveness Costs

• Direct

• Indirect 

 

• Intangible 

• Opportunity

19
Direct Costs

• Medications

• Medical devices

• Computer software and 

equipment 

• Research and development

• Inpatient care

Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed. Oxford, 

England: Oxford University Press; 2002.

Centers for Disease Control. A framework for assessing the effectiveness of disease and injury prevention. MMWR Recommend Report

1992;41(No. RR-3). 20
Indirect Costs

• Change in productivity

• Costs of absenteeism 

• Foregone leisure time 

• Time spent caring for the patient

Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed. Oxford, 

England: Oxford University Press; 2002.

Centers for Disease Control. A framework for assessing the effectiveness of disease and injury prevention. MMWR Recommend Report

1992;41(No. RR-3). 21
Intangible Costs

Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed. Oxford, 

England: Oxford University Press; 2002. 22

• Physical pain and suffering

• Emotional anxiety

• Social stigmatization
Opportunity Costs

23

• Monetary and 

nonmonetary 

• Costs and charges
Prevention effectiveness costs are important to a study 

because they are often the main quantitative variable 

for use in

A. prevention 

B. analysis

C. identification

D. effectiveness

Knowledge Check

24

Choose the best answer from the choices below. 
Topic 5

25

Types of Economic 

Evaluations 
The choice of economic 

evaluations used is 

dependent on

• audience

• study question

• data

Types of Economic Evaluations

26
Method Data inputs used

Outcome value 

desired

Cost analysis Costs Total program or 

intervention cost 

(typically reported as 

cost per patient or cost 

per service rendered)

Cost-effectiveness Net cost of intervention 

versus intervention

effectiveness

Dollars per life saved 

because of an 

intervention

Cost-utility Quality‐adjusted life years 

(QALYs) 

Number of life years 

saved, adjusted to 

account for loss of 

quality

Cost-benefit Money Net costs or savings of 

an intervention

Comparison of Economic Evaluation Methods

27
Cost Analysis

28

• Considers program or 

intervention costs and cost 

of illness

• Achieves cost minimization 

for the program under 

consideration
Cost-Effectiveness Analysis

Compares interventions for the 

same disease or condition 

among a common population

Grosse SD. Presentation to the Canadian Pediatric Endocrine Group 2011 Scientific Meeting, Toronto, Ontario, February 12, 2011. 29
Cost-Utility Analysis

• Considers quality-adjusted life 

years 

• Compares interventions for same 

disease or injury

30
Cost-Benefit Analysis

• Evaluates multiple options 

 

• Compares different options 

among sectors 

Centers for Disease Control and Prevention (CDC). Cost-benefit analysis [self-study course]. Atlanta, GA: US Department of Health and 

Human Services, CDC; [undated]. ttp://www.cdc.gov/owcd/EET/CBA/Fixed/1.html. 31
Choose the correct answer from the choices below. 

A. data

B. cost

C. policy

D. application 

Knowledge Check

32

Selecting the best economic evaluation method is 

dependent on the audience, the study question, 

and the ________________.
Match the data used with each method of analysis 

A. Cost-utility analysis

B. Cost-effectiveness analysis

C. Cost-benefit analysis

D. Cost analysis

A. Cost-utility analysis

B. Cost-effectiveness analysis

C. Cost-benefit analysis

D. Cost analysis

Knowledge Check

33

1. Quality-adjusted life years

2. Cost

3. Money

4. Net cost of intervention versus

 intervention’s effectiveness 
During this course, you learned to

Course Summary

34

• define prevention effectiveness

• describe the key components of prevention 

effectiveness studies

• identify basic economic evaluation methods 

used in prevention effectiveness studies

• identify data used in the most common types 

of economic evaluation methods 
QUESTIONS? 

35
Acknowledgments 

• Ricardo Basurto-Davila, PhD, MSc, Los Angeles County 

Department of Public Health, California

• Paul Farnham, PhD, National Center for HIV/AIDS, Viral 

Hepatitis, STD, and TB Prevention, Centers for Disease 

Control and Prevention, Atlanta, Georgia

• Martin Meltzer, PhD, MS, National Center for Emerging 

and Zoonotic Infectious Diseases

36
Resources and Additional Reading • Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis 

and economic evaluation. 2nd ed. Oxford, England: Oxford University Press; 2002.

• Prosser LA, Bridges CB, Uyeki TM, et al. Health benefits, risks, and cost-effectiveness of influenza 

vaccination of children. Emerg Infect Dis 2006;12:1548–58. 

• Centers for Disease Control. A framework for assessing the effectiveness of disease and injury 

prevention. MMWR Recommend Report 1992;41(No. RR-3).

• Centers for Disease Control and Prevention (CDC). What is prevention effectiveness? Atlanta, 

GA: US Department of Health and Human Services, CDC; 2010. 

http://www.cdc.gov/PEF/WhatIs.html.

• Centers for Disease Control and Prevention (CDC). Framing an economic evaluation [self-study 

course]. Atlanta, GA: US Department of Health and Human Services, CDC; [undated]. 

http://www.cdc.gov/owcd/eet/framing3/1.html.

• Meltzer MI, Cox NJ, Fukuda K. The economic impact of pandemic influenza in the United States: 

priorities for intervention. Emerg Infect Dis 1999;5:659–71. 

• Grosse SD. Presentation to the Canadian Pediatric Endocrine Group 2011 Scientific Meeting, 

Toronto, Ontario, February 12, 2011. 

• Centers for Disease Control and Prevention (CDC). Cost-benefit analysis [self-study course]. 

Atlanta, GA: US Department of Health and Human Services, CDC; [undated]. 

ttp://www.cdc.gov/owcd/EET/CBA/Fixed/1.html. 

• Wagner TH, Engelstad LP, McPhee SJ, Pasick RJ. The costs of an outreach intervention for lowincome women with abnormal Pap smears. Prev Chronic Dis. 2007;4:A11. Epub Dec 15, 2006. 

• Centers for Disease Control and Prevention (CDC). Cervical cancer statistics. Atlanta, GA: US 

Department of Health and Human Services, CDC; 2012. 

http://www.cdc.gov/cancer/cervical/statistics/. 37
Resources and Additional Reading

• Drummond MF, Sculpher MJ, Torrance GW, O’Brien B, Stoddart GL. Methods for the 

economic evaluation of health care programmes. 3rd ed. Oxford, England: Oxford 

University Press; 2005. 

• Gold MR, Siegal JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in health and 

medicine. Oxford, England: Oxford University Press;1996. 

• Patrick DL, Erickson P. Health status and health policy: quality of life in health care 

evaluation and resource allocation. Oxford, England: Oxford University Press; 1993.

• Meltzer MI, Teutsch SM. Setting priorities for health needs, managing resources. In: Stroup 

DF, Teutsch SM, eds. Statistics in public health: quantitative approaches to public health 

problems. Oxford, England: Oxford University Press; 1998.

• Lichtenstein AH. New York City trans fat ban: improving the default option when 

purchasing foods prepared outside of the home. Ann Intern Med 2012;157:144–5.

• Messonnier M. Economics and public health at CDC. MMWR Suppl 2006;55(Suppl 2):17–9.

• O’Brien BJ, Helyland D, Richardson WS, Levine M, Drummond MF. Users’ guides to the 

medical literature. XIII. How to use an article on economic analysis of clinical practice. B. 

What are the results and will they help me in caring for my patients? JAMA 1997;277:1802–

6.

• Stewart KJ. The challenge of cost-effective decision making. Fam Pract Manage 

1996;July/August:16–7.

• Meltzer MI, Cox NJ, Fukuda K. The economic impact of pandemic influenza in the United 

States: priorities for intervention. Emerg Infect Dis 1999;5:659–71.

38
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Centers for Disease Control and Prevention, the Public Health Service, or the U.S. 

Department of Health and Human Services.

The findings and conclusions in this course are those of the authors and do not 

necessarily represent the official position of the Centers for Disease Control and 

Prevention.

Disclaimers 

39
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Visit: http://www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or http://www.cdc.gov/info

The findings and conclusions in this course are those of the authors and do not necessarily represent the official position of the 

Centers for Disease Control and Prevention.

Center for Surveillance, Epidemiology, and Laboratory Services

Division of Scientific Education and Professional Development