Preventive Care With the Most Bang for Your Buck

 Some preventive services are more lifesaving than others, according to a poster presented at the Society of General Internal Medicine (SGIM) 2026 Annual Meeting in Washington, DC.

Investigators evaluated 42 recommendations from the US Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices, ranking them by how many years of quality life would be gained (quality-adjusted life years [QALYs]) and quality years per hour of physician time.

“We often have patients that qualify for up to dozens of preventative care recommendations, and we really have little guidance on how to prioritize,” said Justin Porter, MD, an assistant professor in the Department of Internal Medicine at the University of Chicago, Chicago, who co-led the research. “The costs of prioritizing incorrectly include delaying much needed services or oftentimes not giving them entirely.”

The top six interventions by patient quality years gained were:

• Prescribing preexposure prophylaxis for patients with high-risk sexual activity (0.41 QALYs) and intravenous drug use (0.13)
• Offer to prescribe medications to reduce the risk for breast cancer(0.21)
• Prescribe statins for primary prevention for adults aged 40-75 years at high risk for cardiovascular disease (0.12)
• Screen for alcohol use and provide brief behavioral counseling for adults with hazardous drinking behaviors (0.11)
• Weight-loss counseling and referral to a dietician for adults with obesity (0.07)

When physician time was factored in, the top four services maintained their position but hepatitis B screening for high-risk patients (1.19) and hypertension screening (0.74) rose in value.

Vaccination for respiratory syncytial virus; influenza; and tetanus, diphtheria, and acellular pertussis (TDAP) ranked lowest in QALYs per intervention. Breast cancer screening, folic acid supplementation, and TDAP ranked lowest when physician time was factored in.

The rankings were based on an analysis of approximately 55 time- and cost-effectiveness studies that estimated QALYs for each intervention.

The framework speaks to a common frustration in primary care — managing a growing list of preventive recommendations with limited time, said Jeffrey A. Linder, MD, MPH, chief of general internal medicine at the Northwestern University Feinberg School of Medicine in Chicago, who was not involved in the study.

The findings may help clinicians prioritize their actions, instead of relying on a stream of electronic health record alerts that provide no sense of what matters most, Linder said.

For example, “a lot of people are thinking about cervical cancer screening, but that’s actually lower down on the list,” Linder said. Once the paper has undergone peer review, “I should probably be reordering my thinking and making sure that the women who would benefit from medications to reduce breast cancer are actually on them.”

The analysis also led Linder to rethink the emphasis on statins, which are widely discussed but ranked fourth. Linder said he would like to see researchers include non-USPSTF services, such as controlling high blood pressure, on the list.

Porter presented an example of a 65-year-old woman with obesity: she would be a strong candidate for statins for primary prevention. If she declined the medication, clinicians could move down the list to other services she would qualify for, including behavioral interventions for weight loss, followed by colorectal cancer screening, the latter of which ranked ninth for QALYs gained.

Porter said in an ideal setting, clinicians would have time to execute all preventive services.

“The reality in clinical practice is that you certainly can’t do all of these in one visit,” Porter said. “And because patients are lost to follow-up and there’s a time delay between appointments, the order you choose to do these things does actually matter.”

The authors reported having no disclosures or funding sources. 

https://www.medscape.com/viewarticle/preventive-care-most-bang-your-buck-2026a1000f2p