title: Cost-effectiveness of N-terminal pro-B-type natriuretic-guided therapy in elderly heart failure patients: results from TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure).
abstract: OBJECTIVE
  This study aimed to assess cost-effectiveness of N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided versus symptom-guided therapy in heart failure (HF) patients ≥60 years old.
  
  
  BACKGROUND
  Cost-effectiveness of NT-proBNP guidance in HF patients is unclear. It may create additional costs with uncertain benefits.
  
  
  METHODS
  In the TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure), patients with left ventricular ejection fraction (LVEF) of ≤45% were randomized to receive intensified NT-proBNP-guided therapy or standard, symptom-guided therapy. For cost-effectiveness analysis, 467 (94%) patients (age 76 ± 7 years, 66% male) were eligible. Incremental cost-effectiveness was calculated as incremental costs per gained life-year and quality-adjusted life-year (QALY) within the 18-month trial period, as defined per protocol.
  
  
  RESULTS
  NT-proBNP-guided therapy was dominant (i.e., more effective and less costly) over symptom-guided therapy, saving $2,979 USD (2.5 to 97.5% confidence interval [CI]: $8,758 to $3,265) per patient, with incremental effectiveness of +0.07 life-years and +0.05 QALYs. The probability of NT-proBNP-guided therapy being dominant was 80%, and the probability of saving 1 life-year or QALY at a cost of $50,000 was 97% and 93%, respectively. Exclusion of residence costs resulted in an incremental cost-effectiveness ratio (ICER) of $5,870 per life-year gained. Cost-effectiveness of NT-proBNP-guided therapy was most pronounced in patients <75 years old and in those with <2 significant comorbidities, being dominant in all sensitivity analyses. In the worst-case scenario (excluding residence costs in those with ≥2 comorbidities), the ICER was $11,935 per life-year gained.
  
  
  CONCLUSIONS
  NT-proBNP-guided therapy has a high probability of being cost effective in HF patients with reduced LVEF, particularly in patients age 60 to 75 years or with less than 2 comorbidities. (Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure [TIME-CHF]; ISRCTN43596477).
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Cardiovascular Centre Maastricht, Maastricht, the Netherlands. Electronic address: Sandra.van.wijk@mumc.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sanders-van Wijk
authors.affiliation: Department of Clinical Epidemiology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Antoinette D I
authors.initials: AD
authors.lastname: van Asselt
authors.affiliation: Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
authors.affiliation: Cardiology, University Hospital Liestal, Liestal, Switzerland.
authors.forename: Werner
authors.initials: W
authors.lastname: Estlinbaum
authors.affiliation: Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.affiliation: Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Rickenbacher
authors.affiliation: Cardiology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Andre
authors.initials: A
authors.lastname: Vuillomenet
authors.affiliation: Clinic of Internal Medicine, Kantonales Spital Wolhusen, Sursee, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Peter
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Pfisterer
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Cardiovascular Centre Maastricht, Maastricht, the Netherlands; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002316:Cardiotonic Agents / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D006707:Homes for the Aged / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000378:metabolism*; D019057:Quality-Adjusted Life Years; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: NT-proBNP; cost effectiveness; heart failure