Costs and cost effectiveness of cardiovascular screening and intervention: The British family heart study

Objective-To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. Design-Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. Setting-13 general practices across Britain. Subjects-4185 men aged 40-59 and their 2827 partners. Intervention-Nurse led programme using a family centred approach, with follow up according to degree of risk. Main outcome measures-Cost of the programme itself; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. Results-Estimated cost of putting the programme into practice for one year was pound 63 per person (95% confidence interval pound 60 to pound 65). The overall short term cost to the health service was pound 77 per man (pound 29 to pound 124) but only pound 13 per woman (-pound 48 to pound 74), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was pound 5.08 per man (pound 5.92 including broader health service costs) and pound 5.78 per woman (pound 1.28 taking into account wider health service savings). Conclusions-The direct cost of the programme to a four partner practice of 7500 patients would be approximately pound 58 000. Annually, pound 8300 would currently be paid to a practice of this size working to the ma target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women.