Economic evaluation of community-based lipid testing to improve primary and secondary prevention of cardiovascular disease

The NHS Health Check is designed to identify individuals at high risk of preventive diseases such as cardiovascular disease (CVD) – but uptake remains low. This study aims to evaluate the one-year incremental cost and lifetime cost effectiveness of community-based lipid testing (PocDoc Health Heart Check) compared with the NHS Health Check or primary care medication reviews. An early economic model was developed, which evaluated PocDoc testing in five settings: the workplace, community, pharmacy, at-home via-pharmacy invitation and case-finding from the CVD register. Deterministic sensitivity analysis was used to evaluate uncertainty, and a threshold of £20,000 per quality-adjusted life year (QALY) was used for the incremental cost-effectiveness ratio (ICER). PocDoc’s per-person test cost is lower than the NHS Health Check. However, its higher uptake leads to higher short-term costs. In the short term, the incremental cost compared with standard of care ranges from £6.08 to £36.66 per person. In the long term, PocDoc is a cost-effective use of resources in all test settings: the ICER ranges from £1,915 to £7,884 per QALY. The long-term results are sensitive to changes in lifetime costs and QALYs. Community-based lipid testing using PocDoc Healthy Heart Checks in pharmacies, workplaces and the community could be a cost-effective intervention to identify individuals at high risk of CVD compared with the NHS Health Check. PocDoc testing could also be a cost-effective alternative to medication reviews for people on the UK CVD register who are non-adherent.