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Health checks: no convincing evidence in favour exists, argue academic GPs

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5504 (Published 10 September 2019) Cite this as: BMJ 2019;366:l5504
  1. Elisabeth Mahase
  1. The BMJ

NHS health checks are unlikely to be cost effective, can expose patients to unnecessary interventions, and risk overdiagnosis, concludes the UK Centre for Evidence-Based Medicine.1

The review, carried out by two academic GPs from the University of Oxford, looked at existing evidence on general health checks, including a recent Cochrane review,2 which it said showed that such checks had no significant effect on mortality or cardiovascular outcomes.

In England the NHS Health Checks scheme currently offers checks to everyone aged 40 to 74. They are intended to spot the early signs of major conditions that cause early death, including stroke, kidney disease, heart disease, and type 2 diabetes.

The new review, published in BMJ Evidence-Based Medicine, said that a recent modelling study showed that NHS health checks were unlikely to be cost effective and that targeted policies—such as diet improvement and smoking cessation—were more likely to be cost effective.

The authors said that the focus on general health checks could therefore be costly.

To assess clinical effectiveness the GPs looked at the Cochrane review, which assessed 17 trials involving 251 891 participants in Europe and the US. The Cochrane review found that health checks did not affect total mortality or cancer mortality and had no significant effect on cardiovascular mortality, fatal and non-fatal ischaemic heart disease, and non-fatal stroke. It concluded that “general health checks are unlikely to be beneficial.”

The authors of the new review also pointed out that much of the evidence was low quality, and they called for the research community to “prioritise addressing the uncertainties in the evidence base for the value of health checks.”

They concluded, “There is no convincing evidence to support the implementation of general health checks in primary care. They appear not to affect clinically important outcomes, and there is no high-quality evidence to suggest they are cost-effective, particularly when compared with routine primary care.”

Last month the government announced a review of England’s NHS health checks, which will not consider whether the current system is effective but will instead look at tailoring checks according to risk and at increasing the range of checks offered.3

GPs said that the government’s review must involve a “rigorous evaluation” to ensure that checks are safe, accurate, and of benefit to patients.

References

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