title: Comparative cost-effectiveness of B-type natriuretic peptide and echocardiography for predicting outcome in patients with congestive heart failure.
abstract: Two-dimensional echocardiographic and Doppler variables and B-type natriuretic peptide (BNP) can predict outcomes in patients with congestive heart failure (CHF). However, there is a paucity of data on the relative cost-effectiveness of these modalities in predicting outcome. One hundred sixteen patients hospitalized with CHF underwent simultaneous BNP and Doppler echocardiographic examinations once ready for discharge. The ability of these variables to determine the primary end point (cardiac death or rehospitalization for CHF) was determined. The cost-effectiveness ratios (CER) of 2-dimensional variables, Doppler indexes, and BNP were calculated for prediction of the primary end point. Follow-up was completed in 110 of 116 patients at a mean of 527 days after hospital discharge. Fifty-four patients (50%) reached the primary end point (37 rehospitalizations for CHF and 17 cardiac deaths). When added to a history of admission to the hospital in the preceding year for CHF, a comprehensive Doppler echocardiographic study predicted 52 of 54 events, with a CER of 729.10 dollars, whereas BNP predicted 47 of 54 events (CER 49.98 dollars; p < 0.001 for CER comparison). In patients admitted to hospitals with CHF, predischarge BNP is more cost-effective than comprehensive Doppler echocardiographic examination for the prediction of future cardiac death or rehospitalization for CHF.
authors.affiliation: Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA. hishamd@bcm.tmc.edu
authors.forename: Hisham
authors.initials: H
authors.lastname: Dokainish
authors.forename: William A
authors.initials: WA
authors.lastname: Zoghbi
authors.forename: Eunice
authors.initials: E
authors.lastname: Ambriz
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Lakkis
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Quinones
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
mesh_terms: D000368:Aged; D001774:Blood Chemical Analysis / Q000191:economics*; D003362:Cost-Benefit Analysis; D015150:Echocardiography, Doppler / Q000191:economics*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D020097:Natriuretic Peptide, Brain