title: Cost-effectiveness analysis of serial measurement of circulating natriuretic peptide concentration in chronic heart failure.
abstract: OBJECTIVE
  To assess the cost-effectiveness of three monitoring strategies for optimising medical therapy in chronic heart failure (CHF).
  
  
  METHODS
  This analysis was based on six randomised controlled trials. Costs were measured from a UK NHS perspective and estimated for patients' lifetime. The health outcome was the quality-adjusted life-year (QALY).
  
  
  METHODS
  Hospital and community.
  
  
  METHODS
  Patients with CHF.
  
  
  METHODS
  Serial measurement of natriuretic peptide (NP) by a specialist, clinical assessment by a specialist, and usual care in the community.
  
  
  METHODS
  Costs, QALYs, and incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Serial NP measurement by a specialist was the most cost-effective option in patients with CHF due to left ventricular systolic dysfunction (LVSD), showing an ICER of £3304 compared with clinical assessment. Serial NP measurement by a specialist was strongly favoured in patients with CHF from any cause, for all patients (ICER of £14 694 compared with clinical assessment by a specialist) and for the age subgroup ≤75 years (ICER of £2517 compared with usual care). However, serial NP measurement by a specialist was dominated (less effective and more costly) by alternative strategies in the subgroup age >75 years with CHF from any cause. Clinical assessment by a specialist of patients >75 years of age with CHF from any cause was cost-effective compared with usual care (ICER of £11 508).
  
  
  CONCLUSIONS
  Serial measurement of NP concentration by a specialist is the most cost-effective strategy for CHF due to LVSD and from any cause, except in the subgroup of patients >75 years with CHF from any cause, where treatment guided by NP measurement may be harmful and not cost-effective.
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians, 11 Street Andrew's Place, Regent's Park, London, UK. plaramee@outlook.com
authors.forename: Philippe
authors.initials: P
authors.lastname: Laramée
authors.forename: David
authors.initials: D
authors.lastname: Wonderling
authors.forename: Sharon
authors.initials: S
authors.lastname: Swain
authors.forename: Abdallah
authors.initials: A
authors.lastname: Al-Mohammad
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000097:blood / Q000191:economics*; D006801:Humans; D045265:Natriuretic Peptides / Q000097:blood*; D019057:Quality-Adjusted Life Years
chemical_list: D045265:Natriuretic Peptides