Research Department of Primary Care & Population Health, UCL Institute of Epidemiology & Health Care, London, UK.
Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
J Intellect Disabil Res. 2019 Mar;63(3):233-243. doi: 10.1111/jir.12569. Epub 2018 Nov 21.
The annual health check (AHC) programme, as part of a Directed Enhanced Service, offers an incentive to general practitioners in England to conduct health checks for people with intellectual disabilities (IDs). The aim of this analysis was to estimate the impact on health care costs of AHCs in primary care to the National Health Service in England by comparing adults with ID who did or did not have AHCs using data obtained from The Health Improvement Network.
Two hundred eight records of people with ID from The Health Improvement Network database were analysed. Baseline health care resource use was captured at the time the first AHC was recorded (i.e. index date), or the earliest date after 1 April 2008 for those without an AHC. We examined the volume of resource use and associated costs that occurred at the time AHCs were performed, as well as before and after the index date. We then estimated the impact of AHCs on health care costs.
The average cost of AHC was estimated at £142.57 (95%CI £135.41 to £149.74). Primary, community and secondary health care costs increased significantly after the index date in the no AHC group owing to higher increase in resource utilisation. Regression analysis showed that the expected health care cost for those who have an AHC is 56% higher than for those who did not have an AHC. Age and gender were also associated with increase in expected health care cost.
The level of resource utilisation increased in both (AHC and no AHC) groups after the index date. Although the level of resource use before index date was lower in the no AHC group, it increased after the index date up to almost reaching the level of resource utilisation in the AHC group. Further research is needed to explore if the AHCs are effective in reducing health inequalities.
年度健康检查（AHC）计划作为定向增强服务的一部分，为英格兰的全科医生提供了激励措施，以对智障人士（ID）进行健康检查。本分析旨在通过比较有或没有 AHC 的 ID 成年人的医疗保健成本，来估计 AHC 对英格兰国民保健服务的影响。
从健康改善网络数据库中分析了 208 份 ID 成人的记录。在记录首次 AHC 时（即索引日期）或没有 AHC 的情况下在 2008 年 4 月 1 日之后最早的日期捕获基线医疗保健资源使用情况。我们检查了在进行 AHC 时发生的资源使用量和相关成本，以及在索引日期之前和之后。然后，我们估计了 AHC 对医疗保健成本的影响。
AHC 的平均费用估计为 142.57 英镑（95%CI 135.41-149.74）。在没有 AHC 的组中，由于资源利用的增加，索引日期后初级、社区和二级医疗保健成本显著增加。回归分析表明，有 AHC 的人的预期医疗保健费用比没有 AHC 的人高 56%。年龄和性别也与预期医疗保健费用的增加有关。
在索引日期之后，两组（AHC 和无 AHC）的资源利用率都有所增加。尽管在无 AHC 组中，索引日期前的资源使用水平较低，但在索引日期后，它增加到几乎达到 AHC 组的资源利用水平。需要进一步研究以探索 AHC 是否能有效减少健康不平等。
