What are the cost-savings and health benefits of improving detection and management for six high cardiovascular risk conditions in England? An economic evaluation.

OBJECTIVES: To estimate the cost savings and health benefits of improving detection of individuals at high risk of cardiovascular disease (CVD) in England, to determine to which patient subgroups these benefits arise, and to compare different strategies for subsequent management. DESIGN: An economic analysis using the School for Public Health Research CVD Prevention Model. SETTING: England 2018. PARTICIPANTS: 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. INTERVENTIONS: Detection of 100% of individuals with CVD high risk conditions compared with current levels of detection in England. Detected individuals are assumed to be managed either according to current levels of care or National Institute of Health and Care Excellence (NICE) guidelines. MAIN OUTCOME MEASURES: Incremental and cumulative costs, savings, quality adjusted life years (QALYs), CVD cases, and net monetary benefit, from a UK NHS and Personal Social Services perspective. RESULTS: £68 billion could be saved, 4.9 million QALYs gained and 3.4 million cases of CVD prevented over 25 years if all individuals in England with the six CVD high risk conditions were diagnosed and subsequently managed at current levels. Additionally, if all detected individuals were managed according to NICE guidelines, total savings would be £61 billion, 8.1 million QALYs would be gained and 5.2 million CVD cases prevented. Most benefits come from detection of high cholesterol in the short term and diabetes in the long term. CONCLUSIONS: 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.

Attitudes towards smokefree high streets: a survey of local shoppers in a northern UK town.

OBJECTIVE:: As a local authority we wanted to practically determine the perception of the public to smokefree zones in shopping high streets and other local outdoor public places. METHODS:: A survey was carried out by students on a convenience sample of shoppers on a single busy market day in Barnsley. RESULTS:: In all, 142 responses were collected; 28% were smokers and 15% e-cigarette users. The majority (69%) of respondents were not against smokefree high streets, including 68% of smokers; 69% of respondents (including 61% of smokers) were not against all public areas becoming smokefree; 70% of respondents (including 63% of smokers) were not against outdoor seating areas, such as those outside pubs and cafés becoming smokefree. There was a marginal preference that smokefree outdoor zones should be voluntary (42%) rather than enforced (39%). Most respondents believed that people smoking around children was influential in determining whether those children go on to take up smoking when they get older. Most smokers (92%) said they already moderated their smoking behaviour in some way when children were present, including 44% who claimed that when children are around they do not smoke at all. CONCLUSION:: This study gives strength to the argument for local authorities to implement voluntary outdoor smokefree zones in public places such as shopping high streets, as a part of a comprehensive tobacco control plan. Shoppers were generally supportive of smokefree zones and in particular where the rationale for their implementation is to protect children from taking up smoking.