Title: workH.O.R.S.E: working Health Outcomes Research Simulation Environment
Funder: Department of Health and Social Care

Abstract: BACKGROUND The NHS Health Check Programme (NHS HCP) seeks to identify and manage people at high risk of cardiovascular disease (CVD) and diabetes. What is the potential for further improvements in health, equity and cost-effectiveness? AIM This project will provide a validated open source/open access, flexible model enabling local commissioners to quantify the potential and cost effectiveness for population health gain of the NHS Health Check Programme, by building on the solid foundation of our existing IMPACTncd model. OBJECTIVES AND RESEARCH PLAN OBJECTIVE 1: Model Development. We will further develop our proven and tested IMPACTncd computer model to include more diseases (heart disease, stroke, diabetes, and kidney disease, dementia, atrial fibrillation; alcohol misuse, cancers and Chronic Obstructive Pulmonary Disease). To support local commissioning, the model will also compare different implementation approaches and support sophisticated scenario specifications. This validated, fully stochastic generic microsimulation model will include a prototype user interface to help commissioners model the implementation of the NHS HCP at local level. OBJECTIVE 2: Updating the evidence base. To inform model development and delivery, we will build on existing evidence-based guidelines and systematic reviews (SRs) and conduct new SRs. Key parameters to reflect programme implementation will include eligibility, annual coverage, uptake, risk profile, treatment prescription and adherence, brief interventions, and referrals to lifestyle services. OBJECTIVE 3: Assess and compare the alternative strategies for the NHS Health Check Programme. As specified in the NIHR call, we will explore the effectiveness of the NHS HCP, and compare cases detected, cases prevented, deaths prevented or postponed, number needed to attend to prevent a case; life expectancy, disease-free life expectancy; and QALYs. Results will be stratified by age, gender, ethnicity and socioeconomic position (to facilitate equity impact analysis). Health economics analysis will include cost utility analysis (cost per QALY), incremental cost-effectiveness ratios and net monetary benefit. We will also conduct extensive probabilistic sensitivity analyses. OBJECTIVE 4: Stakeholder engagement. We will recruit and engage a diverse group of stakeholders. This will powerfully strengthen the user perspective, refine desirable features of the user interface and identify additional, locally relevant scenarios to test. OBJECTIVE 5: Develop a sustainability and implementation plan to deploy workHORSE as a user-friendly web-based decision model. We will ensure open access to the model, refine scalability strategies and provide recommendations for incorporating local data, and designing and implementing local scenarios. This will include piloting a secure cloud-based platform to allow local commissioners to run their own scenarios. IMPORTANT OUTCOMES Our project will deliver an open source, scalable, decision-support model for use with local or national data. Flexible scenario design features to accommodate and assess changes in NHS HCP delivery and eligibility criteria will enable commissioners to explore the potential for increased effectiveness, cost-effectiveness and population health gain. DISSEMINATION We will publicise our findings via diverse stakeholders, organisations, websites, Health Check users, media, conferences and papers in academic and general journals.

Lay abstract: BACKGROUND The NHS Health Check programme is offered to all adults in England aged 40-74. It is designed to spot early signs of risk before the onset of serious diseases like stroke, heart disease, type 2 diabetes, kidney disease, or dementia. If any such risks are found, the programme then provides support and treatment to improve that person’s future health. However, some studies have suggested that the current NHS Health Check programme could perhaps be improved. Our existing, computer model has already been successfully used to examine the NHS Health Check programme both nationally and locally in Liverpool. We will now develop this into a new, improved model called workHORSE. That new, user-friendly computer tool will be designed to be very straightforward for local commissioning teams to use to further improve delivery of their local NHS Health Check programme. OUR AIM We will therefore further develop our existing computer model to help local commissioners, decision makers and stakeholders to: • examine the local NHS Health Check disease prevention programme, • assess how it is currently used and make improvements, • look at different future scenarios and measure how diseases might be reduced most cost-effectively. METHODS Our workHORSE computer model will calculate the current and potential future benefits of the programme. It will estimate the scope for further reduction in nine major diseases (including heart attacks, strokes, diabetes, dementia and lung disease). It will also look at the cost-effectiveness of different ways to achieve these disease reductions, and how best to reduce health inequalities. To do this, we will systematically review scientific papers and relevant documents to identify the best evidence to feed into the model calculations. We will then further develop our proven and tested computer model to expand the number of diseases it considers, and allow for developments and changes to the NHS Health Check programme. We will recruit stakeholders to tell us what users actually want. These stakeholders will advise on desirable features of the user-friendly model and suggest additional locally relevant scenarios to test. PATIENT AND PUBLIC INVOLVEMENT We have recruited four lay persons to advise us on the development of the proposal, research design, stakeholder recruitment and workshops, document review, and dissemination of research findings, including preparation of press releases. OUTPUTS We will then compare the effectiveness and cost-effectiveness of different strategies for improving the NHS Health Check programme. Our model will thus enable local commissioners to calculate the costs and benefits of these different components of the Health Checks programme, potential improvements, and the likely reductions in health inequalities. DISSEMINATION We will share our computer model widely, with all interested parties. We will also publicise our findings via relevant organisations, stakeholders, health check users, scientific conferences, journals, media releases and the wider public.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE