Population-level health and economic impact of a national cardiovascular prevention programme: a 10-year evaluation of the National Health Services’ Health Check
F Re, S Nakhare, H Young, M Shah, M Jaffar-Karballai, A Schmidt, K Chhatwal, V Velmurugan, C F Petri, N S Peters, M A Kelshiker, P BachtigerAbstract
Background
Cardiovascular disease (CVD) remains a leading cause of premature mortality and widening health inequalities. The NHS Health Check programme is one of the largest prevention initiatives globally, but despite substantial public investment, definitive evidence on its long-term clinical effectiveness and economic value at scale is lacking.
Purpose
To evaluate the ten-year clinical and health economic impact of NHS Health Checks on mortality, cardiovascular events, healthcare utilisation, and cost-effectiveness.
Methods
A retrospective population-based cohort study was conducted using linked whole-system data covering 2.7 million residents in the United Kingdom between 2015 and 2025. Adults aged 40-74 years eligible for NHS Health Check and without pre-existing CVD or diabetes were included. Inverse probability of treatment weighting balanced baseline demographic and socioeconomic differences between attendees and non-attendees. Weighted Cox models estimated associations with all-cause mortality and major adverse cardiovascular events (MACE). Healthcare utilisation and costs were measured using negative binomial and regression models. Cost-effectiveness was calculated over ten years using restricted mean survival time to derive quality-adjusted life years (QALYs).
Results
Among 974,299 eligible adults, 445,446 (48.1%) attended at least one Health Check. Uptake showed marked socioeconomic gradients, with 2.4% attendance in the most deprived groups compared to 12.6%-15% across mid-deprivation deciles. Attendance enabled detection of cardiometabolic risk, including hypertension (2.4%), diabetes (1.3%), and dyslipidaemia (62.3%), initiation of guideline-directed therapy in up to 70% of individuals, and sustained prescribing at 12-18 months (54%). After weighting and sequential adjustment, non-attendance was associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.35; 95% confidence interval [95%CI] 1.30-1.41) and MACE (HR: 1.31; 1.27-1.37). Over ten years, one premature death was prevented for every 30 attendees and one first MACE for every 168 attendees. Attendance was associated with greater engagement with primary and planned care, and lower rates of MACE-related hospitalisation and inpatient expenditure. Over ten years, attendance generated 0.09 QALYs gained for cardiovascular outcomes (incremental cost-effectiveness ratio [ICER] £10,998 per QALY) and 0.03 QALYs for mortality (ICER £36,499 per QALY), consistent with UK willingness-to-pay thresholds.
Conclusions
NHS Health Check attendance was associated with reduced long-term mortality and cardiovascular events and a shift towards planned healthcare expenditure, representing a cost-effective prevention strategy. However, inequalities in uptake limit population impact. Maximising health gain will require identification and targeting of engageable non-attending high-risk groups and integration within accessible, routine care pathways.