title: Cost-utility analysis of nt-probnp-guided multidisciplinary care in chronic heart failure.
abstract: OBJECTIVE
  A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective.
  
  
  METHODS
  Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality.
  
  
  RESULTS
  BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000.
  
  
  CONCLUSIONS
  NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.
authors.affiliation: Department of Internal Medicine III (Cardiology and Emergency Medicine), Landesklinikum St. Poelten, St. Poelten, Austria. deddo.moertl@stpoelten.lknoe.at
authors.forename: Deddo
authors.initials: D
authors.lastname: Moertl
authors.forename: Sabine
authors.initials: S
authors.lastname: Steiner
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.forename: Rudolf
authors.initials: R
authors.lastname: Berger
mesh_terms: D001317:Austria; D015415:Biomarkers / Q000097:blood; D002170:Canada; D002423:Cause of Death; D003362:Cost-Benefit Analysis; D005102:Health Expenditures / Q000706:statistics & numerical data; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000628:therapy*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D008390:Markov Chains; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D057184:Practice Patterns, Nurses' / Q000191:economics; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain