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050 Vertical reviews – informing policy decisions on clinical vs community-oriented approaches to prevent disease – a potential path to reduce overdiagnosis?

ebmed · 2025-09-02 · canonical JSON source

4 visible annotations · policy: published · automated confidence ≥ 75.00%

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In the last half a century, a new approach to improve public health has gained momentum - preventing disease in large proportions of the general, low-risk population through individually oriented interventions provided by healthcare personnel. This expansion of medical territory is one of the drivers of overdiagnosis by labelling asymptomatic people as ‘at risk’ and thereby make them eligible for medical care. Apart from potential harmful consequences for the individual, this may also cause indirect harm through opportunity costs, i.e. reduced access to higher-value care for people who are sick. It may also draw resources from other societal activities with greater importance for public health than healthcare itself.A potential solution to address this driver of overdiagnosis could be that policy makers, when considering implementing a new intervention within healthcare, carefully consider whether there are alternative, community-oriented strategies to address the same health issue. This would require transparent and trustworthy summaries of the available evidence comparing the benefits, harms, costs and potential for clinical opportunity costs of clinical interventions versus community-oriented interventions.In this project, we aim to introduce a novel method for such evidence syntheses, which we call Vertical Reviews. The agenda of Vertical Reviews is to inform policy makers on the relative efficiency of clinical versus community-oriented interventions to prevent morbidity and mortality from the same health issue, and thereby facilitate prioritization of resources to maximize the beneficial effects for public health.The aim of this workshop is to present the concept of Vertical Reviews and seek input from the audience on how to develop and improve the method. In small-group discussions, participants will reflect on the potential relevance and feasibility of Vertical Reviews in their contexts. Specific attention will be given to the potential role of Vertical Reviews in reducing overdiagnosis.