Walkley, R; Allen, AJ; Cowie, MR; Maconachie, R; Anderson, L
(2023)
The cost-effectiveness of NT-proBNP for assessment of suspected acute heart failure in the emergency department.
ESC Heart Fail, 10 (6).
pp. 3276-3286.
ISSN 2055-5822
https://doi.org/10.1002/ehf2.14471
SGUL Authors: Anderson, Lisa
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Abstract
AIMS: When relying on clinical assessment alone, an estimated 22% of acute heart failure (AHF) patients are missed, so clinical guidelines recommend the use of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for AHF diagnosis. Since publication of these guidelines, there has been poor uptake of NT-proBNP testing in part due to concerns over excessive false positive referrals resulting from the low specificity of a single 'rule-out' threshold of <300 pg/mL. Low specificity can be mitigated by the addition of age-specific 'rule-in' NT-proBNP thresholds. METHODS AND RESULTS: A theoretical hybrid decision tree/semi-Markov model was developed, combining global trial and audit data to evaluate the cost-effectiveness of NT-proBNP testing using age-specific rule-in/rule-out (RI/RO) thresholds, compared with NT-proBNP RO only and with clinical decision alone (CDA). Cost-effectiveness was measured as the incremental cost per quality-adjusted life year (QALY) gained and incremental net health benefit. In the base case, using UK-specific inputs, NT-proBNP RI/RO was associated with both greater QALYs and lower costs than CDA. At a willingness-to-pay threshold of £20 000/QALY, NT-proBNP RO was also cost-effective compared with CDA [incremental cost-effectiveness ratio (ICER) of £8322/QALY], but not cost-effective vs. RI/RO (ICER of £64 518/QALY). Overall, NT-proBNP RI/RO was the most cost-effective strategy. Sensitivity and scenario analyses were undertaken; the conclusions were not impacted by plausible variations in parameters, and similar conclusions were obtained for the Netherlands and Spain. CONCLUSIONS: An NT-proBNP strategy that combines an RO threshold with age-specific RI thresholds provides a cost-effective alternative to the currently recommended NT-proBNP RO only strategy, achieving greater diagnostic specificity with minimal reduction in sensitivity and thus reducing unnecessary echocardiograms and hospital admissions.
Item Type: | Article | ||||||||
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Additional Information: | © 2023 Roche Diagnostics Ltd and The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. | ||||||||
Keywords: | Acute heart failure, Cost-effectiveness, Diagnosis, Emergency department, NT-proBNP, NT-proBNP, Emergency department, Acute heart failure, Cost-effectiveness, Diagnosis, 1102 Cardiorespiratory Medicine and Haematology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||
Journal or Publication Title: | ESC Heart Fail | ||||||||
ISSN: | 2055-5822 | ||||||||
Language: | eng | ||||||||
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Publisher License: | Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0 | ||||||||
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PubMed ID: | 37697738 | ||||||||
Web of Science ID: | WOS:001065757200001 | ||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/115861 | ||||||||
Publisher's version: | https://doi.org/10.1002/ehf2.14471 |
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