National evaluation of the NHS Health Check programme

Introduction: I aimed to evaluate the performance of the National Health Service (NHS) Health Check in the first four years since April 2009. The programme offers all English adults aged 40-74 years, and without known vascular disease, a cardiovascular disease (CVD) risk assessment and management Health Check every five years. Methods: Electronic medical records of 300,000 random sample of patients who were aged 40-74 years old but not filtered by other Health Check eligibility criteria were obtained from a nationally representative UK primary care database. Multilevel logistic regression was performed to examine variations in programme coverage. Programme impact on the management of CVD risks and early detection of selected vascular conditions was examined using a difference-in-differences matching analysis. A model-based cost-utility analysis was conducted to estimate the relative long-term costs and benefits of the NHS Health Check with a lifetime time horizon. Results: National coverage of the programme was low in the first four years and varied between general practices and English regions although no significant differences were observed between areas of different levels of deprivation. The programme had contributed to a statistically significant but clinically modest reduction in global CVD risk and individual risk factors among attendees but smoking prevalence stayed unchanged. The prescribing of statins increased significantly but the absolute statin prescribing remained low after Health Checks. The programme appears to be cost-effective long-term, based on the benefits of medical and lifestyle interventions being realised. Conclusions: The NHS Health Check needs to be improved substantially via better planning, implementation, monitoring, and management before any anticipated public health benefit are achieved. High-quality research is required to identify the most effective strategies such as a combination of CVD risk assessment programme and other population-wide programmes for the prevention of CVD.Open Acces