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CVD health check can be limited to one in 12 adults, study finds

Targeting just one in 12 adults for a cardiovascular check-up has many of the same benefits and is far more cost-effective than inviting everyone over a certain age, a study has found.

The study, published today in the BJGP, saw researchers calculating a CVD risk score from risk factors in electronic medical records (using the QRISK algorithm) then simulated what would happen using various screening strategies for 10,000 patients between 30 and 74 using data from The Health Improvement Network database (THIN).

They found that the most cost-effective strategy was to only invite those with higher risk scores to check ups – only 8% of the population, rather than everyone over 40 as is done through the NHS Health Checks programme.

They assessed three strategies:

  • inviting all patients above a certain age to attend (the NHS Health Checks approach);
  • opportunistic assessment (identifying high risk patients when they attend the GP for another issue); and
  • active invitation for those identified at high risk by medical records.

They found that the final option was the optimal strategy based on lifetime costs and quality adjusted life years (QUALYs).

This approach of inviting 8% of those assessed at highest risk (over 12.8% predicted 10-year CVD risk) gave 17.53 QUALYs, costing £162,280. In contrast, inviting everyone in the sample yielded 30.32 QALYs costing £705,732.

Study lead Professor Tom Marshall, professor of public health and primary care at the University of Birmingham Institute of Applied Health Research, 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.’

It comes as earlier this year, Public Health England said it will review the evidence behind its NHS Health Checks programme after a Government-funded evaluation of the scheme found it has fallen ‘well short’ of performance targets.

Jamie Waterall, national lead for the NHS Health Check Programme, 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.'

 

 

Readers' comments (2)

  • But doesn't it have the issue of self-selection -ie it only works if we've got enough data already.

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  • Just to clarify. The process of ranking patients by pre-calculated risk requires only the cardiovascular risk factors which are already available in electronic patient records. Electronic records have everybody's age and sex. They have smoking status and blood pressure for the majority of patients. In fact the ranking would work almost as well even if we only had records of our patients' age and sex.

    I hope this clarifies. I will get back to worrying about President Trump now.

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