title: Potential costs of B-type natriuretic peptide for the identification of people with heart failure in primary care in Scotland - a pilot study.
abstract: OBJECTIVE
  The utility of B-type natriuretic peptide as a screening test for heart failure has been proven in a number of clinical trials. The aims of this study were to assess the utility of the measurement of B-type natriuretic peptide in a 'real life' setting and to estimate the potential costs of implementing its use in primary care in Scotland.
  
  
  RESULTS
  Eight general practitioner practices with a combined population of approximately 62,000 were invited to participate. During the 9-month study period, 82 samples for B-type natriuretic peptide measurement were requested. The negative predictive value for B-type natriuretic peptide was 96.9%. Compared with electrocardiography, B-type natriuretic peptide reduced the need for echocardiography by 308 tests per million population per year. The estimated cost of implementation in Scotland is approximately £220,000 per annum, equating to £64.93 per patient correctly diagnosed with heart failure, with a potential saving in echocardiography of £110,800.
  
  
  CONCLUSIONS
  In this pilot study, measurement of plasma B-type natriuretic peptide in a 'real life' setting in primary care had a similar sensitivity, specificity and negative predictive value to that observed in trial populations. B-type natriuretic peptide aids early diagnosis of heart failure in primary care and may help to facilitate prompt introduction of evidence based therapies to modify patient outcomes. The costs of measuring plasma B-type natriuretic peptide in suspected cases of heart failure are modest, and its use would increase the diagnostic capacity of primary care if supported by local cardiology services.
authors: M Denvir, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK. Email martin.denvir@ed.ac.uk.
authors: A R
authors: AR
authors: Chapman
authors: S J
authors: SJ
authors: Leslie
authors: S W
authors: SW
authors: Walker
authors: C
authors: C
authors: Bickler
authors: M A
authors: MA
authors: Denvir
mesh_terms: D017046:Cost Savings; D003955:Diagnostic Tests, Routine / Q000191:economics*; D004452:Echocardiography / Q000191:economics; D006333:Heart Failure / Q000175:diagnosis* / Q000191:economics; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000191:economics*; D012606:Scotland; D012680:Sensitivity and Specificity
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: brain natriuretic peptide; heart failure; primary care; screening