The cost-effectiveness of population Health Checks: have the NHS Health Checks been unfairly maligned?

Abstract

AimThe English NHS currently has a policy of providing Health Checks to all 40–74 year olds. Administered in primary care, they aim to identify patients at risk of a range of diseases, including diabetes and heart disease, and facilitate care. This study is the first to use observed data on the effectiveness of the Checks to consider whether they represent a cost-effective use of limited NHS resources.Subject and methodsUsing a publicly available evaluation tool we conducted an analysis of the Checks to establish the long-term cost and health-related outcomes of a cohort of patients. The primary focus of the analysis was to establish whether the impact of the Checks on BMI was sufficient to justify their cost.ResultsThe Checks were associated with a reduction in mean BMI of 0.27 (95% CI 0.20 to 0.34) compared to no Check. When applied to the evaluative tool, a small but positive QALY gain of 0.05 per participant was observed, coupled with a reduction in disease-related care costs of £170 ($210 USD). When the estimated cost per Check (£179, $220 USD) is taken into account, we estimate an incremental cost-effectiveness ratio of £900/QALY ($1109 USD/QALY).ConclusionsMuch of the criticism of the Health Checks has focussed on the relatively small average change in risk factors such as BMI. However, this analysis suggests that the significant health and cost-saving benefits from even a modest reduction in mean BMI, coupled with the low costs of the Checks, combine to result in a potentially highly cost-effective policy.Electronic supplementary materialThe online version of this article (doi:10.1007/s10389-017-0801-8) contains supplementary material, which is available to authorized users.

Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users

“…Overall, our results suggest a lower health and economic impact than some of the early evidence, and are more consistent with the more modest gains reported by Mytton et al 26 and Hinde et al 8 A direct comparison of these modelling exercises is unfortunately not feasible because the scenarios are not directly comparable, the geographies are different and the modelling methods differ substantially.…”

Delivery and impact of the NHS Health Check in the first 8 years: a systematic review

“…In the economic models, lower than anticipated coverage, for example, would merely reduce aggregated costs and aggregated health gains, without affecting the cost per QALY estimates. 7,40 Like other interventions (bariatric surgery, for instance) 41 and some pharmaceuticals (which might be subjected to a 'budget impact test'), 42,43 it seems NHS Health Checks may thus be simultaneously costeffective and unaffordable. 40 A pragmatic response might be to focus attention on targeting the distribution of NHS Health Checks towards those who would benefit most, and/or towards reducing health inequalities.…”

“…7,40 Like other interventions (bariatric surgery, for instance) 41 and some pharmaceuticals (which might be subjected to a 'budget impact test'), 42,43 it seems NHS Health Checks may thus be simultaneously costeffective and unaffordable. 40 A pragmatic response might be to focus attention on targeting the distribution of NHS Health Checks towards those who would benefit most, and/or towards reducing health inequalities. The finding that coverage (the proportion of the eligible population who have attended an NHS Health Check) among those in the most deprived areas was higher than average, despite uptake (the proportion of those invited who have attended an NHS Health Check) among those groups being lower (and the findings from the study by Attwood et al in which the direction of association between sociodemographic characteristics and uptake was reversed after adjusting for GP practice), 34 suggests that this is already happening to some degree.…”

NHS Health Check and healthy lifestyle in Leicester, England: analysis of a survey dataset

“…30,36,38,43,44 in terms of lifestyle advice provided as part of the NHS Health Check, some studies reported benefits, some reported no benefits and some reported mixed results. 34,[44][45][46][47][48][49] Peer reView satisfied with the lifestyle advice and some were not. 34,35,45,47,49 Some participants found the lifestyle advice non-personalised, were confused about how it was communicated or were confused about the follow-ups.…”