NHS Health Checks: value for money?

Reports in the Guardian and Telegraph this week report on a study published in the Journal of Public Health suggesting that the NHS health checks are costing £450,000 per life saved and therefore represent very poor value for money.

Unfortunately these press reports are woefully misleading, although the study itself does little to discourage such misrepresentation.  What the media describes as a study is not actually a cost-effectiveness analysis, or indeed any empirical research, but an invited debate outlining the arguments for and against health checks.  The relevant text states that “preventing 1000 deaths annually could cost up to £450 000 per death avoided (£450m/1000 deaths)… they … make the much quoted NICE estimate of ‘around £3000 per QALY’ look rather fanciful.”

Firstly, the 1000 deaths prevented is suggested as the likely benefit of the health checks by the authors rather than an empirical estimate.  Secondly, media reports state that £450,000 per life saved renders the scheme poor value for money.  However the reports are fundamentally wrong and have misinterpreted the numbers.

Suppose the patients whose lives are saved live for a further 20 years in perfect health – the gain for those patients would be 20 life years, and because this is perfect health the patients gain 20 Quality Adjusted Life Years (QALYs).  Investing £450,000 to gain 20 QALYS equates to £22,500 per QALY gained – somewhat higher than NICE’s modelling, but actually of borderline cost-effectiveness (NICE suggests a value of £20,000 to £30,000 to be the upper limit of what is ‘reasonable’ to pay for a year of perfect health).  If those 20 years are lived in less than perfect health then the cost per QALY will be correspondingly higher, but it is unlikely to be up in the hundreds of thousands of pounds.

In other words, if (and it is a big if) the health checks do save 1000 lives a year for £450m, then compared with what else the NHS currently spends they may not be such bad value for money after all.

Whatever the shortcomings of health checks it is important that economic arguments do not get misrepresented.  Here lives saved are being confused with (quality adjusted) life years gained.  Journalists and academics should take care to compare like with like.

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