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Incremental care is a philosophy that holds that there are medical options falling along the entire cost spectrum for most health conditions and that all the available options should be discussed with pet owners.
This is in contrast to “gold standard care,” in which only the most effective and (usually) most expensive treatment options are, at least initially, presented.
This philosophy recognizes that responsible pet ownership is demonstrated when a veterinary care team is contacted and is not dictated by the subsequent healthcare decisions, which may be constrained by financial or other factors.
By engaging in a conversation about the range of possible options, pet parents are more likely to consider themselves a partner in their pet's care, as opposed to a customer simply paying for a service.
It is recognized that there are some conditions that do not have low‐cost options available and therefore humane euthanasia must always be considered an acceptable course of action if quality of life could deteriorate to an unacceptable level.
2.2.3 Cautions
Licensing boards and legislatures are inconsistent in their approach to standards of care in veterinary medicine (see 9.5 Better Understanding Standard of Care). Be sure to understand the current interpretations of standards before offering any healthcare option that may be considered “substandard.”
Recommended Reading
1 Stull, J.W., Shelby, J., Bonnett, B. et al. (2018). Barriers and next steps to providing a spectrum of effective health care to companion animals. Journal of the American Veterinary Medical Association. 253 (11): 1386–1389.
2.3 Prevalence and Incidence
Samuel Stewart, DVM, DACVECC and Chand Khanna, DVM, PhD, DACVIM (Onc), DACVP (Hon)
Ethos Veterinary Health, Woburn, MA, USA
2.3.1 Summary
Prevalence and incidence are both terms used to describe the occurrence of a disease over a period of time. Prevalence is defined by the number of individuals alive with a disease, while incidence is defined by the number of newly diagnosed cases of a disease divided by the population at risk of developing that disease. Incidence is often not able to be described in veterinary medicine as the population at risk of developing a given disease process is generally not known and would require a pet census. Additionally, it assumes that there is a steady rate of disease occurrence over a specified period of time, which is not always true of disease states. In veterinary studies prevalence is more commonly used as it does not require definition of the at‐risk patient population.
2.3.2 Terms Defined
Epidemiology: The study of how diseases occur in given patient populations and why.
Incidence: The rate of newly diagnosed cases of a given disease process in a specified period of time.
Prevalence: The number of cases of a disease process that occur in a specified period of time.
2.3.3 Introduction
Epidemiology is the study and analysis of diseases in a given population of people or animals. It focuses on factors of disease, such as cause, risk factors, frequency, and distribution/pattern. The purpose for the study of these factors is the goal of achieving control of the disease process (i.e., means to reduce its occurrence) or to define the size of a market before developing and commercializing an innovation for disease.
Prevalence and incidence are terms commonly used when describing the study of epidemiology. Prevalence is the actual number of cases that are alive and affected by a specific disease in a given period of time. Incidence is the calculated risk of an individual acquiring a disease in a given period of time. Both variables can be defined as disease occurrence within a certain amount of time (rate) or within a specified population (proportion).
Prevalence and incidence are expressed as fractions, which allows for the estimation between the probability of disease and the various factors that can influence that probability. The numerator of the fraction represents the number of patients that have the disease (for prevalence) or the number of newly diagnosed cases of disease (for incidence). The denominator represents the size of the population from which the individuals were drawn (for prevalence) or the size of the at‐risk group of individuals (for incidence). The denominator can also be expressed in relation to time (e.g., cases of disease/population time).
2.3.4 Key Differences
Prevalence can be expressed over a period of time, referred to as period prevalence, and can also be expressed at a specific point in time, known as point prevalence. Point prevalence does not provide as good a measurement of disease as period prevalence as it is only accounting for cases alive with that disease at a given point in time and does not look at new cases and deaths over a defined time period.
Incidence refers to the number of newly diagnosed cases of a given disease. It is expressed as a fraction of the number of new cases of disease divided by the population at risk of developing the disease (e.g., 100 cases per 100 000 people = 0.001). In essence, incidence allows for determination of an individual's probability of being diagnosed with a disease during a given period of time.
There are two ways in which incidence can be expressed: incidence risk and incidence rate. Incidence risk (also known as cumulative incidence) refers to number of at‐risk individuals in a given population that become new cases of disease during the defined follow‐up period (e.g., 30 cases per 1000 individuals per three years). There are multiple ways in which the follow‐up period can be defined, such as a fixed duration (e.g., three years), the lifetime of the individual (e.g., lifetime incidence risk of kidney disease), or based on the duration of a given epidemic. Incidence rate (also known as incidence density) refers to the number of new cases of a disease per person‐time in the at‐risk population. This approach requires dividing the number of new cases by the number of years being evaluated. Using the example above, an incidence risk of 30 cases per 1000 individuals per three years would equal an incidence rate of 10 cases per 1000 individual years.
The natural progression of a disease greatly defines the relationship between incidence and prevalence. Diseases that have a high rate of spontaneous resolution will result in high incidence of disease but possibly low prevalence as the disease will be resolved in many of the patients depending on the
