Tailoring the NHS Health Check: Targeted, Cost-Effective Screening for Cardiovascular Disease Prevention

Abstract

Since 2009, England's National Health Service (NHS) offers 40-74 year-olds in England free health screenings every five years through its NHS Health Check. The program is designed to prevent cardiovascular disease (CVD) and other noncommunicable diseases. Recent research suggests the NHS Health Check's cost-effectiveness may be improved by targeting patients based on their CVD risk levels. This thesis aims to identify the optimal CVD screening policy for the English population given current budget constraints. We propose a dynamic solution approach in which we formulate and solve a series of Mixed-Integer Quadratically Constrained Programs. Using this approach, we determine the optimal targeted national and regional screening policies for a synthetic English population. We also consider two greedy policies, in which individuals are prioritized based on CVD risk, and an incumbent policy, which replicates the current implementation of the NHS Health Check. We test the performance of each policy in a health simulator. In simulation, the targeted national policy performs best for the synthetic population. Compared to the incumbent policy, we estimate it prevents an additional 5,800 CVD cases and prevents or postpones an additional 18,000 CVD cases per NHS Health Check cohort of 3.4 million individuals. Our results suggest the NHS Health Check could prevent or postpone more CVD cases with its existing screening budget by allocating more screenings early in the screening period and tailoring screening frequency to individuals' anticipated risk trajectories.