BMJ 1996;312:1265-1268 (18 May)

General practice

Costs and cost effectiveness of health checks conducted by nurses in primary care: the Oxcheck study

Susan Langham, lecturer in health economics,a Margaret Thorogood, senior lecturer,a Charles Normand, professor of health policy,a John Muir, senior research fellow,b Lesley Jones, computer scientist,b Godfrey Fowler, clinical reader in general practice b

a Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC2E 7HT, b Imperial Cancer Research Fund General Practice Research Group, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: Professor Normand.

Abstract

Objective: To measure the costs and cost effectiveness of the Oxcheck cardiovascular risk factor screening and intervention programme.
Design: Cost effectiveness analysis of a randomised controlled trial using clinical and economc data taken from the trial.
Setting: Five general practices in Luton and Dunstable, England.
Subjects: 2205 patients who attended a health check in 1989-90 and were scheduled for re-examination in 1992-3 (intervention group); 1916 patients who attended their initial health check in 1992-3 (control group). Participants were men and women aged 35-64years.
Intervention: Health check conducted by nurse, with health education and follow up according to degree of risk.
Main outcome measures: Cost of health check programme; cost per 1 % reduction in coronary risk.
Results: Health check and follow up cost £29.27 per patient. Estimated programme cost per 1% reduction in coronary risk per participant was between £1.46 and £2.25; it was nearly twice as much for men as women.
Conclusions: The cost to the practice of implementing Oxcheck-style health checks in an average sized practice of 7500 patients would be £47 000, a proportion of which could be paid for through staff pay reimbursements and Band Three health promotion target payments. This study highlights the considerable difficulties faced when calculating the costs and benefits of a health promotion programme. Economic evaluations should be integrated into the protocols of randomised controlled trials to enable judgments to be made on the relative cost effectiveness of different prevention strategies.

Key messages

  • Research was undertaken to estimate the cost of the health checks and relate the cost to changes in the relative risk of cardiovascular disease

  • The immediate cost of implementing Oxcheck-style health checks in an average sized practice of 7500 patients would be £47 000, which is comparable with the immediate cost of a cervical screening programme

  • The actual costs to the practice would be substantially reduced by staff pay reimbursements and health promotion target payments

  • Further research is required to estimate the wider costs of health checks resulting from the additional use of health care services


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