Targeted screening offers same benefits as health check at lower cost

Millet, D. GP Online. Published online: 8 November 2016


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.

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.

Read the overview here

Read the original research article here

Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial

Dixon, P. et al. BMJ Open. 6:e012352

B0007043 Man using computer

Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objectives: To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.

Design: A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.

Setting: Patients recruited through primary care, and intervention delivered via telehealth service.

Participants: Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.

Intervention: A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.

Primary and secondary outcome measures: Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.

Results: 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.

Conclusions: There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.

Read the full article here