NHS Health Check programme: too early to concludeBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4785 (Published 30 July 2014) Cite this as: BMJ 2014;349:g4785
- John N Newton, chief knowledge officer1,
- Adrian Davis, deputy director population health science1,
- Jamie Waterall, national lead, NHS Health Check programme1,
- Kevin A Fenton, director of health and wellbeing1
It would be a shame if the debate about the Inter99 trial was limited to the points raised in the accompanying editorial by Gøtzsche and colleagues.1 2 Olsen has already pointed out in his rapid response that the stark message of the editorial’s title is not supported by its content.3 The NHS Health Check Expert Scientific and Clinical Advisory Panel has reviewed the Inter99 trial and we highlight below some of our conclusions.4
The study is not directly comparable to the NHS Health Check programme. Patients in the NHS programme are older and seem to have worse underlying cardiovascular disease risk than those in the Danish study. Evidence emerging from the NHS programme confirms that substantial levels of undiagnosed treatable illness are being detected. The intervention assessed was also very different. Clinical management of newly detected diabetes, renal disease, or hypertension is part of the NHS Health Check programme, whereas Inter99 was mainly a low intensity lifestyle intervention with the option of referral to primary care.
A population level impact from screening for cardiovascular risk is hard to measure using an intention to treat analysis. Even though participants receiving the intervention achieved positive lifestyle changes, an effect at population level could not be detected after 10 years.
The outcome of the Inter99 trial is indeed reason to reflect on the value and design of population based health check programmes and the research needed to assess them. For example, modelling suggests that redirecting effort towards higher risk people would improve cost effectiveness.5 Opportunistic screening in primary care alone is not an adequate response and may worsen inequalities. Public health authorities must therefore design integrated strategies to reduce cardiovascular risk that are tailored to the risk profile of their populations and that reflect other aspects of the local context.
Cite this as: BMJ 2014;349:g4785
Competing interests: All the authors are employed by Public Health England, the organisation responsible at national level for delivery of the NHS Health Check programme.
Full response at: www.bmj.com/content/348/bmj.g3680/rr/703359.