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Table 1 Rational for including or excluding health conditions

From: Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks

Health condition

Included/ excluded

Rationale

Arthritis

Excluded

Despite a high prevalence, the expected impact on costs and outcomes was likely to be low or medium due to uncertainties around optimal identification and management; in addition there was no consistent evidence of whether AHC would improve the identification or management of arthritis.

High blood pressure (hypertension)

Included

The expected impact on costs and outcomes was high; robust (cost-) effectiveness evidence for blood pressure management was available; evidence was also available that showed that AHC led to improved identification and management of high blood pressure.

Body mass index, weight, cholesterol

Excluded

Overall, there was only limited evidence that AHC was able to influence those health promotion outcomes.

Bowel cancer screening

Included

The expected impact on costs and outcomes was high because of a high prevalence of the condition, the availability of a national screening programme, and the availability of (cost-) effective treatment; although uptake has not been considered in the evaluations of AHCs there is evidence that additional information provided by general practitioners increases uptake.

Breast cancer (screening via mammogram)

Included

The expected impact on costs and outcomes was high because of the high prevalence of the condition, the availability of a national screening programme, and of cost-effective treatment; although uptake has not been considered in the evaluations of AHCs there is evidence that additional information provided by general practitioners increases uptake.

Cataract

Included

The expected impact on costs and outcomes was high because of the high prevalence, availability of (cost-) effective treatment, and strong evidence that AHCs led to an increase in eye tests.

Cervical cancer screening

Excluded

The expected impact on costs and outcomes was low because of the low prevalence in this population.

COPD and asthma

Excluded

Evidence was insufficient: the prevalence of asthma was not well established for this population; there was no evidence that AHC would lead to changes in the identification or management of COPD or asthma.

Dementia

Excluded

Evidence was insufficient; in particular it was not clear whether dementia was currently checked in AHCs, and whether AHCs led to better identification.

Epilepsy

Excluded

Evidence was insufficient; in particular there was not enough robust evidence of cost-effective treatment.

Heart disease

Included (indirectly)

Heart disease was modelled as a consequence of hypertension and diabetes, which were strong predictors of heart disease. Heart disease was not modelled separately to avoid double of counting economic consequences.

Hearing impairment

Included

The expected impact on costs and outcomes was high due to the high prevalence and high impact for this population. There was robust evidence that AHC led to an increase in hearing tests; (cost-) effective treatment was available.

Glaucoma

Included

The expected impact on costs and outcomes was high; the impairment linked to glaucoma was and there was strong evidence that AHC led to more eye tests being carried out; (cost-) effective treatment was available.

Hip fracture

Included (indirectly)

This was modelled as a consequence of osteoporosis, which was a strong predictor fracture. Hip fracture was not modelled separately to avoid double counting of economic consequences.

Immunisation status

Excluded

The expected impact on costs and outcomes was low; checking for immunisation status is part of another incentivised scheme in primary care. This suggested a more limited role of AHCs in further improving uptake.

Lung cancer/ smoking

Excluded

The expected impact on costs and outcomes was low due to lack of evidence of cost-effective treatment options that would be influenced by an earlier identification; also lack of robust evidence whether identification improved through AHC.

Mental health

Excluded

Evidence was insufficient; whilst prevalence data were available, there was no evidence about whether AHC led to a better identification of mental health problems; there was also a lack of evidence regarding (cost-) effective treatment options for this population.

Osteoporosis (screening)

Included

The expected impact on costs and outcomes was high due the high prevalence and the availability of screening tools that led to an increase in the identification of osteoporosis and reduction in (costly) fractures. Screening for osteoporosis is covered by the new AHC tool in England.

Prostate cancer

Excluded

Evidence was insufficient; prevalence data were not available and there was no robust evidence about (cost-) effective treatment options and whether AHCs led to increase in identification or improved management of the condition.

Stroke

Included (indirectly)

This was modelled as a consequence of hypertension and diabetes, which were strong predictors of stroke. Stroke was not modelled separately to avoid double counting economic consequences.

Thyroid problems

Excluded

There is an overall lack of evidence suggesting that expected impact of identification or monitoring through annual health checks is likely to have a large impact on costs or health outcomes.