BMJ 1996;312:1269-1273 (18 May)

General practice

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study

David Wonderling, research fellow in health economics,a Christine McDermott, research fellow in health economics,a Martin Buxton, professor of health economics,a Ann-Louise Kinmonth, professor of primary medical care,b Stephen Pyke, lecturer in medical statistics,c Simon Thompson, reader in medical statistics,c David Wood, honorary consultant cardiologist d

a Health Economics Research Group, Brunel University, Uxbridge, Middlesex UB8 3PH, b Primary Medical Care, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, c Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, d Department of Clinical Epidemiology, National Heart and Lung Institute, London SW3 6LY

Correspondence to: Professor Buxton.

Abstract

Objective: To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme.
Design: Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates.
Setting: 13 general practices across Britain.
Subjects: 4185 men aged 40-59 and their 2827 partners.
Intervention: Nurse led programme using a family centred approach, with follow up according to degree of risk.
Main outcome measures: Cost of the programme itself; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year.
Results: Estimated cost of putting the programme into practice for one year was £63 per person (95% confidence interval £60 to £65). The overall short term cost to the health service was £77 per man (£29 to £124) but only £13 per woman (-£48 to £74), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was £5.08 per man (£5.92 including broader health service costs) and £5.78 per woman (£1.28 taking into account wider health service savings).
Conclusions: The direct cost of the programme to a four partner practice of 7500 patients would be approximately £58 000. Annually, £8300 would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women.

Key messages

  • Patient specific data from the British family heart study are used in this detailed cost effectiveness analysis

  • The costs of the programme to general practitioners was estimated with reasonable precision: an average four partner practice of 7500 patients will require 1.75 nurse years to implement this programme, costing £58 000

  • The direct costs of the programme may not be fully reimbursed under the current health promotion banding scheme

  • The broader impact on drug costs and use of other health care resources is uncertain, and larger trials will be needed to estimate these important effects


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