Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction.
OBJECTIVE
This study was designed to evaluate the cost-effectiveness of screening patients with a B-type natriuretic peptide (BNP) blood test to identify those with depressed left ventricular systolic function.


BACKGROUND
Asymptomatic patients with depressed ejection fraction (EF) may have less progression to heart failure if they can be identified and treated.


METHODS
We used a decision model to estimate economic and health outcomes for different screening strategies using BNP and echocardiography to detect left ventricular EF <40% for men and women age 60 years. We used published data from community cohorts (gender-specific BNP test characteristics, prevalence of depressed EF) and randomized trials (benefit from treatment).


RESULTS
Screening 1,000 asymptomatic patients with BNP followed by echocardiography in those with an abnormal test increased the lifetime cost of care (176,000 US dollars for men, 101,000 US dollars for women) and improved outcome (7.9 quality-adjusted life years [QALYs] for men, 1.3 QALYs for women), resulting in a cost per QALY of 22,300 US dollars for men and 77,700 US dollars for women. For populations with a prevalence of depressed EF of at least 1%, screening with BNP followed by echocardiography increased outcome at a cost < 50,000 US dollars per QALY gained. Screening would not be attractive if a diagnosis of left ventricular dysfunction led to significant decreases in quality of life or income.


CONCLUSIONS
Screening populations with a 1% prevalence of reduced EF (men at age 60 years) with BNP followed by echocardiography should provide a health benefit at a cost that is comparable to or less than other accepted health interventions.
Heidenreich
Paul A
PA
11C Cardiology, VA Palo Alto Health Care System, Palo Alto VAMC, 3801 Miranda Avenue, Palo Alto, CA 94034, USA. heiden@stanford.edu
Gubens
Matthew A
MA
Fonarow
Gregg C
GC
Konstam
Marvin A
MA
Stevenson
Lynne W
LW
Shekelle
Paul G
PG
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D020097:Natriuretic Peptide, Brain