Is B-type natriuretic peptide-guided heart failure management cost-effective?
BACKGROUND
Chronic heart failure (CHF) is a common medical problem and B-type natriuretic peptide (BNP)-guided heart failure management for outpatients with symptomatic CHF was found to reduce the readmission rate and mortality, but the costs of treatment may provoke concern in the current cost-conscious clinical setting.


METHODS
We conducted a cost-effectiveness analysis using a Markov model of regular BNP measurement in the outpatient setting. The target population was symptomatic CHF patients aged 35-85 years recently discharged from the hospital. Intervention was BNP measurement once every 3 months (BNP group) or no BNP measurement (clinical group). Clinical and utility data were retrieved from published studies. Costs were based on published data in the US. Cost-effectiveness was measured by $ per quality-adjusted life year (QALY).


RESULTS
The baseline analysis during the 9-month period after hospitalization showed the QALY to be longer for the BNP group (0.57 for the BNP group and 0.55 for the clinical group) and the costs were also lower for the BNP group ($9577 and 10,131). The dominance of the BNP group continued during the 1-year follow-up. The incremental costs would be $3491-7787 per QALY. In sensitivity analyses, two parameters with strong effects on the cost-effectiveness were the probability of the first readmission for CHF in the clinical group and the costs for inpatient CHF care. When these two parameters were simultaneously put on the simulation model, the incremental costs of the BNP group may exceed $50,000.


CONCLUSIONS
Introduction of BNP measurement in heart failure management may be cost-effective.
Morimoto
Takeshi
T
Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Hayashino
Yasuaki
Y
Shimbo
Takuro
T
Izumi
Tohru
T
Fukui
Tsuguya
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000191:economics*; D011237:Predictive Value of Tests; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain