Tens of billions of pounds could also be saved for the NHS if treatment was improved, researchers estimate.
Millions more years of good health and multi-billions of pounds could be saved for the NHS if people with conditions that increase their risk of cardiovascular disease (CVD) were diagnosed and treated better, suggests research published in the journal BMJ Open.
UK researchers calculated that potential savings of around £68bn could be achieved for the NHS and 3.4million cases of CVD prevented over 25 years if all people in England with high-risk CVD conditions were diagnosed and managed according to official guidelines.
Cardiovascular disease prevention is a global public health priority and currently, there are more than 1.8 million people in England on the Coronary Heart Disease Register and more than one million on the Stroke or Transient Ischaemic Attacks Register. CVD is estimated to have cost the UK economy around £23.3bn overall in 2015.
NHS England has, as part of its strategy to improve CVD prevention, highlighted six high risk conditions for CVD that are currently under-diagnosed and insufficiently well managed despite a range of available interventions.
These conditions include hypertension (high blood pressure), atrial fibrillation (irregular and often rapid heart rate), diabetes (type 1 and 2), and chronic kidney disease.
Increasing diagnosis and management of these six conditions could be an achievable way of making health improvements and potentially save NHS costs, but to date, there has been little quantification of the potential benefits carried out.
A team of researchers from the University of Sheffield and Rotherham Metropolitan Borough Council set out to estimate the total cost savings and health benefits that could be achieved if it were possible to detect all individuals with the six high risk conditions in England – assuming diagnosed individuals would be either managed to current care levels, or optimally, according to National Institute for Health and Care Excellence (NICE) guidelines.
They carried out an economic analysis using a CVD prevention model focused on English NHS and social services. Baseline patient characteristics were taken from the Health Survey for England of 2014 to enable a patient population representative of England to be modelled.
The study’s subjects were adults aged 16 and older with one or more high cardiovascular risk conditions, including hypertension, diabetes, non-diabetic hyperglycaemia, atrial fibrillation, chronic kidney disease and high cholesterol.
The outcome measures used by the researchers were incremental and cumulative costs, savings, and quality-adjusted life years (QALYs) – a measure of the state of health of a person or group in which the benefits, in terms of length of life, are adjusted to reflect the quality of life.
The researchers also measured net monetary benefit from a NHS and personal social services perspective in the UK, measured at 5, 10 and 25-year points.
Interventions that were included in the model were selected from NICE guidance for each of the high risk conditions.
• diagnostic interventions (NHS Health Check, annual review for people with a pre-existing high risk condition)
• drug interventions (lipid modification, antihypertensives, anticoagulants and diabetes treatments)
• lifestyle interventions (weight management, smoking cessation, education for diabetes, and nutritional advice for chronic kidney disease)
• interventions to improve adherence to other interventions (blood pressure self-monitoring, medicines use review).
Their analysis showed that if all people with CVD high risk conditions were diagnosed and then managed appropriately at current levels, £68bn could be saved, 4.9million QALYs gained and 3.4million cases of CVD prevented over a 25-year-period.
Additionally, if all detected people were managed according to NICE guidelines, the total savings would be £61bn, 8.1million QALYs would be gained and 5.2million CVD cases prevented.
The greatest benefits would come from detection of high cholesterol in the short term and diabetes in the long term.
The study had some limitations, said the authors, such as the fact that results depended on accurate modelling of current care in England which relied on a range of data sources that were sometimes based on a limited sample.
In addition, the CVD prevention benefits of improving detection and management could be underestimated because the model did not include some vascular conditions such as peripheral vascular disease.
Nevertheless, it was based on a model that included most elements of current CVD prevention practice in people at high risk, so allowed for a valid comparison of different detection and management scenarios.
They concluded: “Substantial cost savings and health benefits would accrue if all individuals with conditions that increase CVD risk could be diagnosed, with detection of undiagnosed diabetes producing greatest benefits.
“Ensuring all conditions are managed according to NICE guidelines would further increase health benefits. Projected cost-savings could be invested in developing acceptable and cost-effective solutions for improving detection and management.”