Targeted screening offers same benefits as health check at lower cost

Offering health checks to just the 8% of patients most at-risk of developing cardiovascular disease offers similar health benefits to national screening at a far lower cost, researchers have concluded.

Offering health checks to all patients aged 40-74 in the national NHS Health Check is a ‘poor use of resources’, a modelling study has suggested.

A targeted approach to assessing cardiovascular disease in patients provides similar benefits to national screening, but at a fraction of the cost according to the research, published in the British Journal of General Practice (BJGP).

A total of 10,000 patients aged 30-74 who did not have existing cardiovascular disease or diabetes were involved in the study.

Researchers from the University of Birmingham ran several simulations to model the costs of different approaches to screening patients.

It showed that performing no case finding and inviting all the patients involved in the study for a cardiovascular check would yield 30.32 QALYs (quality-adjusted life years) – years lived without disease – at a cost of £706,000.

In another simulation, they ranked the patients by cardiovascular risk and invited only the top 8% to attend a check. This yielded 17.52 QALYs, but cost considerably less at £162,000.

Health checks

Patients’ 10-year risk scores of developing cardiovascular disease were calculated using data available in their GP medical records – including age, gender and smoking habits – with the QRISK2 algorithm.

The team used published sources to estimate the uptake of assessment, treatment initiation and treatment effects.

They concluded that this latter strategy was ‘clearly superior’ because it resulted in a more cost-effective way to improve patients’ quality of life.

Because fewer lower-risk patients ended up requiring treatment, inviting more patients than the 8% most at-risk resulted in ‘diminishing returns’, they added.

‘Across all age ranges, targeted case finding using a prior estimate of cardiovascular disease risk is more efficient than universal case finding in healthy adults,’ they wrote.

They continued: ‘It is more cost effective to prioritise patients for CVD risk factor assessment than to offer it to all individuals over a certain age; the most efficient prioritisation makes use of multiple risk factors but the incremental benefits of case finding across the entire population are small in relation to the incremental costs.’

Lead author Professor Tom Marshall said: ‘This study has important implications for the future of CVD screening. Our findings highlight the need to re-evaluate existing screening programmes, which may not be the best use of staff time.

‘A focused screening programme targeted on those at highest risk, rather than everyone aged over 40, would result in significant cost savings for the NHS while retaining the most of the health benefits. Our research also raises the question of whether other mass screening programmes might be better targeted.’

Jamie Waterall, national lead for the NHS Health Check programme at Public Health England (PHE), said: ‘We know that people with the greatest health need are benefiting from the NHS Health Check programme.

‘PHE’s expert scientific and clinical advisory panel continually reviews new research into cardiovascular disease prevention, and will consider these findings and their implications for the NHS Health Check programme. We will continue to work with partners to ensure the programme achieves its full potential.’

Photo: JH Lancy

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