Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK

Kypridemos, Chris ORCID: 0000-0002-0746-9229, Collins, Brendan ORCID: 0000-0002-3023-8189, Mchale, Philip ORCID: 0000-0002-8560-2291, Bromley, Helen, Parvulescu, Paula, Capewell, Simon ORCID: 0000-0003-3960-8999 and O'Flaherty, Martin ORCID: 0000-0001-8944-4131 (2018) Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK. PLOS Medicine, 15 (05). e1002573-.

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Abstract

Background: Aiming to contribute to prevention of cardiovascular disease (CVD), the National Health Service (NHS) Health Check programme has been implemented across England since 2009. The programme involves cardiovascular risk stratification—at 5-year intervals—of all adults between the ages of 40 and 74 years, excluding any with preexisting vascular conditions (including CVD, diabetes mellitus, and hypertension, among others), and offers treatment to those at high risk. However, the cost-effectiveness and equity of population CVD screening is contested. This study aimed to determine whether the NHS Health Check programme is cost-effective and equitable in a city with high levels of deprivation and CVD. Methods and findings: IMPACTNCD is a dynamic stochastic microsimulation policy model, calibrated to Liverpool demographics, risk factor exposure, and CVD epidemiology. Using local and national data, as well as drawing on health and social care disease costs and health-state utilities, we modelled 5 scenarios from 2017 to 2040: Scenario (A): continuing current implementation of NHS Health Check; Scenario (B): implementation ‘targeted’ toward areas in the most deprived quintile with increased coverage and uptake; Scenario (C): ‘optimal’ implementation assuming optimal coverage, uptake, treatment, and lifestyle change; Scenario (D): scenario A combined with structural population-wide interventions targeting unhealthy diet and smoking; Scenario (E): scenario B combined with the structural interventions as above. We compared all scenarios with a counterfactual of no-NHS Health Check. Compared with no-NHS Health Check, the model estimated cumulative incremental cost-effectiveness ratio (ICER) (discounted £/quality-adjusted life year [QALY]) to be 11,000 (95% uncertainty interval [UI] −270,000 to 320,000) for scenario A, 1,500 (−91,000 to 100,000) for scenario B, −2,400 (−6,500 to 5,700) for scenario C, −5,100 (−7,400 to −3,200) for scenario D, and −5,000 (−7,400 to −3,100) for scenario E. Overall, scenario A is unlikely to become cost-effective or equitable, and scenario B is likely to become cost-effective by 2040 and equitable by 2039. Scenario C is likely to become cost-effective by 2030 and cost-saving by 2040. Scenarios D and E are likely to be cost-saving by 2021 and 2023, respectively, and equitable by 2025. The main limitation of the analysis is that we explicitly modelled CVD and diabetes mellitus only. Conclusions: According to our analysis of the situation in Liverpool, current NHS Health Check implementation appears neither equitable nor cost-effective. Optimal implementation is likely to be cost-saving but not equitable, while targeted implementation is likely to be both. Adding structural policies targeting cardiovascular risk factors could substantially improve equity and generate cost savings.

Item Type:	Article
Additional Information:	copyright: All rights reserved shorttitle: Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme urldate: 2018-05-29 keywords: Cardiovascular diseases, Coronary heart disease, Cost-effectiveness analysis, Diabetes mellitus, England, Meta-analysis, Socioeconomic aspects of health, Stroke file: Kypridemos et al_2018_Future cost-effectiveness and equity of the NHS Health Check cardiovascular.pdf:C\:\Users\ckypr\Zotero\storage\WNME3CD5\Kypridemos et al_2018_Future cost-effectiveness and equity of the NHS Health Check cardiovascular.pdf:application/pdf;Snapshot:C\:\Users\ckypr\Zotero\storage\2YYLFDLQ\article.html:text/html
Uncontrolled Keywords:	Humans, Cardiovascular Diseases, Program Evaluation, Risk Reduction Behavior, Models, Theoretical, Forecasting, Adult, Aged, Middle Aged, Cost-Benefit Analysis, State Medicine, Female, Male, Health Status Disparities, United Kingdom
Depositing User:	Symplectic Admin
Date Deposited:	30 May 2018 06:37
Last Modified:	19 Jan 2023 01:33
DOI:	10.1371/journal.pmed.1002573
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3021887