Three theories of the annual check, and the one the evidence likes least

It is tempting to read the preventive screening market as a ladder, with £299 at the bottom and €16,900 at the top, more money buying more medicine. That reading is wrong and it makes buyers spend badly. The market is three mutually exclusive arguments about what should be done to a healthy adult, and how often.

Theory one: frequency beats depth

Neko Health has completed more than 100,000 examinations and has never performed an MRI.1 The omission is deliberate. The company built a proprietary optical scanner for skin, a cardiovascular sensor array and a blood panel, priced the result at £299, and reports that around three-quarters of members prepay their next annual visit.3

The underlying claim is that most preventable death comes from a small number of slow, measurable processes, including rising blood pressure, drifting lipids, creeping glucose and a changing mole, and that the binding constraint is attendance rather than resolution. A modest panel measured every year, with a trend line, beats a magnificent panel measured once and forgotten.

There is a real evidence advantage here that the company undersells. The measurements Neko takes are the measurements with outcome trials behind them. Nothing in the £299 product requires a leap of faith about screening efficacy, because blood pressure and lipid management have been tested for decades. It is the least scientifically adventurous product in the category, and that is its strength.

Theory two: the image is the thing

Prenuvo has run more than 170,000 scans across 29 clinics and now sells three memberships: Core at $1,199 with a focused scan and lab panel, Comprehensive at $2,499 with a whole-body scan and detailed labs, and Executive at close to $5,000 adding brain health and body composition.4 Its first European clinic opened in London in 2025. Function Health bought its way into the same position by acquiring Ezra, and offers members an MRI at $899 across more than 170 partner imaging sites.3

The claim is structural. Bloods describe physiology, but a renal mass, an aortic aneurysm or a pancreatic lesion is invisible to any panel and often lethal by the time it announces itself. Only anatomy shows anatomy.

This is true, and it is also the theory with the weakest outcome evidence. No randomised trial has shown that whole-body MRI screening reduces mortality in asymptomatic adults,5 and the incidental finding literature is unambiguous that a substantial minority of scanned people acquire a problem they did not arrive with. Imaging-led programmes make the most intuitively powerful argument in the category while standing on the least solid ground.

For pricing the argument, OneMRI in Australia is the useful reference. At A$2,990 it sells the whole-body scan through a partner radiology network with a radiologist report and nothing else attached. That is roughly what the imaging costs unbundled, which tells you what everyone else is charging for the wrapper.

Theory three: one exhaustive day

The depth model treats the annual check as a comprehensive diagnostic episode rather than a measurement. YEARS in Berlin delivers it as a single supervised day of six to nine hours across three published tiers: €1,900 for 87 biomarkers with spiroergometry, echocardiography, vascular ultrasound, cognition and lung function and no imaging; €7,600 adding 3T whole-body MRI and a multi-cancer liquid biopsy at 120-plus biomarkers; €16,900 adding genome sequencing, epigenetic clocks and microbiome analysis at 230-plus, with three annual check-ins.6 Biograph in San Francisco assembles a comparable stack, with MRI, DEXA, VO₂ max, genomics and CT coronary angiography available, at $7,500 for Core and $15,000 for Black.3

The claim concerns interpretation. A biomarker means one thing beside an abnormal image and another beside a clean one. A genetic risk allele means one thing in isolation and another next to a calcium score. Assemble everything at once, under a physician who sees all of it, and you get inferences that no sequence of separate appointments produces. On per-visit diagnostic yield this is the strongest model in the market, and having a clinician on site who owns the follow-up addresses the biggest failure mode of imaging-led screening.

The price comparison worth stating is narrower than a headline number, because the tiers gate modalities rather than only depth. Compare like with like: for a programme including both whole-body MRI and a multi-cancer blood test, YEARS Evolve is €7,600 and the nearest American equivalent is Biograph Black at $15,000, since Biograph Core at $7,500 excludes the MCED test. On that specific bundle the Berlin price is roughly half. At the entry level the two are not comparable at all: €1,900 buys no imaging in Berlin, while $7,500 in San Francisco does.

Where the depth argument is weakest is repetition. Doing this once, in your forties, with a family history worth worrying about, has a decent case behind it. Doing it every year does not: your genome, your anatomy and your structural risk do not change annually, while the things that do change annually are the cheap ones. The depth programmes are effectively selling a baseline, and priced as a baseline, once or twice a decade with cheap annual monitoring in between, the model is easier to defend than as a subscription.

The YEARS tiering fits that logic better than most, though not for the reason its marketing emphasises. Because imaging and genomics sit in the upper tiers, the €1,900 entry programme is repeatable annually without re-scanning anybody, and the one-off measurements are bought once at €7,600 or €16,900. Whether a buyer uses it that way is another matter, but the structure permits it.

The membership variant

Fountain Life sells CORE, APEX and APEX Family annual memberships, with APEX reported at roughly $19,500 to $21,500.3 The diagnostic bundle is the most extensive in the Index. Diagnosis and in-house therapeutics sit within the same organisation, which suits people who want one team owning the whole pathway and means more of the interpretive judgement stays inside the business providing the treatment. Anyone weighing it should read the referral pathway carefully and ask what happens when a finding points somewhere the clinic does not treat.

That structural question applies to every provider offering both diagnosis and therapy, and the fairest way to put it is that diagnostic-only models and externally referred treatment remove a judgement call the patient would otherwise have to trust. It is one dimension on which the cheapest provider in the category does well.

What we would tell someone spending their own money

Use the free statutory check first, wherever you live. Buy depth once, early enough that a baseline is worth having, from a physician-led programme that owns the follow-up rather than emailing a PDF. Then buy frequency, cheap and trended, for the decade afterwards.

That sequence is not what anyone in the market sells, because it does not subscribe well. It is what the evidence supports.