title: Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study.
abstract: OBJECTIVE
  Prevention of cardiovascular disease and heart failure (HF) in a cost-effective manner is a public health goal. This work aims to assess the cost-effectiveness of the St Vincent's Screening TO Prevent Heart Failure (STOP-HF) intervention.
  
  
  RESULTS
  This is a substudy of 1054 participants with cardiovascular risk factors [median age 65.8 years, interquartile range (IQR) 57.8:72.4, with 4.3 years, IQR 3.4:5.2, follow-up]. Annual natriuretic peptide-based screening was performed, with collaborative cardiovascular care between specialist physicians and general practitioners provided to patients with BNP levels >50 pg/mL. Analysis of cost per case prevented and cost-effectiveness per quality-adjusted life year (QALY) gained was performed. The primary clinical endpoint of LV dysfunction (LVD) with or without HF was reduced in intervention patients [odds ratio (OR) 0.60; 95% confidence interval (CI) 0.38-0.94; P = 0.026]. There were 157 deaths and/or emergency hospitalizations for major adverse cardiac events (MACE) in the control group vs. 102 in the intervention group (OR 0.68; 95% CI 0.49-0.93; P = 0.01). The cost per case of LVD/HF prevented was €9683 (sensitivity range -€843 to €20 210), whereas the cost per MACE prevented was €3471 (sensitivity range -€302 to €7245). Cardiovascular hospitalization savings offset increased outpatient and primary care costs. The cost per QALY gain was €1104 and the intervention has an 88% probability of being cost-effective at a willingness to pay threshold of €30 000.
  
  
  CONCLUSIONS
  Among patients with cardiovascular risk factors, natriuretic peptide-based screening and collaborative care reduced LVD, HF, and MACE, and has a high probability of being cost-effective.
  
  
  BACKGROUND
  NCT00921960.
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.|School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Ledwidge
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Connell
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.|School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gallagher
authors.affiliation: St James Hospital, National Centre for Pharmacoeconomics, Dublin, Ireland.
authors.forename: Lesley
authors.initials: L
authors.lastname: Tilson
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: James
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.|School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Victor
authors.initials: V
authors.lastname: Voon
authors.affiliation: School of Pharmacy, University College, Cork, Ireland.
authors.forename: Margaret
authors.initials: M
authors.lastname: Bermingham
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.
authors.forename: Elaine
authors.initials: E
authors.lastname: Tallon
authors.affiliation: School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Chris
authors.initials: C
authors.lastname: Watson
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.
authors.forename: Rory
authors.initials: R
authors.lastname: O'Hanlon
authors.affiliation: St James Hospital, National Centre for Pharmacoeconomics, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Barry
authors.affiliation: St Vincent's University Hospital, Chronic Cardiovascular Disease Management Unit, Dublin, Ireland.|School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Kenneth
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000097:blood* / Q000191:economics* / Q000517:prevention & control; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010348:Patient Care Team; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000191:economics / Q000517:prevention & control
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Cardiovascular prevention; Cost-effectiveness; Heart failure; Left ventricular dysfunction; Natriuretic peptide screening; Primary care