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Objective To determine the costs and cost-effectiveness of health checks done by nurses in primary care (a cardiovascular risk factor screening and intervention programme). Design Cost-effectiveness analysis of data taken from a randomised controlled trial with 3-year follow-up (Oxcheck Study). Setting 5 general practices in Luton and Dunstable, England. Patients 4121 patients aged 3 5 to 64 years who responded to a lifestyle questionnaire. Intervention 2205 patients were allocated to a health check in the first year of the study (1989 to 1990) (intervention group). 1916 patients were allocated to an initial health check in the fourth year of the study (1992 to 1993) (control group). Health checks took a mean time of 45 minutes and were done by nurses using a defined protocol, with health education and follow-up according to degree of risk for cardiovascular disease. Main cost and outcome measures Outcomes (overall reduction in coronary risk, overall cost of the health check programme, and cost per 1 % reduction in the relative risk [RR] for cardiovascular disease per patient, derived from the Dundee risk score) were measured after 3 years of followup. Cost data were extracted retrospectively from financial records or were estimated from subsamples. Main results The health check programme reduced the RR for cardiovascular disease by 20% for attenders of the final examination only and by 13% if nonattenders were also included. The mean cost per patient attending for screening, with an average amount of follow-up, to the general practices of the health check programme was £29.27. The nurses' time made up 64% of the cost. The estimated cost of the health check programme to the practices per 1% reduction in the RR for cardiovascular disease per patient was £1.46, when calculated based on attenders only, and£2.25, when calculated for all patients scheduled to attend for re-examination. The mean cost per 1 % reduction in coronary risk was lower for women (£1.22 for attenders, £1.72 for all patients scheduled) than for men (£1.63 for attenders, £4.18 for all patients scheduled). Conclusion The estimated cost of the health check programme to the participating general practices was between £1.46 and £2.25 per 1% reduction in coronary risk per patient.



Evidence-Based Medicine

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