Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis.
BACKGROUND
Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) is now standard care in this disease. The existing Australian Scleroderma Interest Group algorithm (ASIGSTANDARD ) is based on transthoracic echocardiography (TTE) and pulmonary function tests (PFT). Recently, ASIG has derived and validated a new screening algorithm (ASIGPROPOSED ) that incorporates N-terminal pro-B-type natriuretic peptide level together with PFT in order to decrease reliance on TTE, which has some limitations. Right heart catheterisation (RHC) remains the gold standard for the diagnosis of PAH in patients who screen 'positive'.


OBJECTIVE
To compare the cost of PAH screening in SSc with ASIGSTANDARD and ASIGPROPOSED algorithms.


METHODS
We applied both ASIGSTANDARD and ASIGPROPOSED algorithms to 643 screen-naïve SSc patients from the Australian Scleroderma Cohort Study (ASCS), assuming a PAH prevalence of 10%. We compared the costs of screening, the number of TTE required and both the total number of RHC required and the number of RHC needed to diagnose one case of PAH, and costs, according to each algorithm. We then extrapolated the costs to the estimated total Australian SSc population.


RESULTS
In screen-naïve patients from the ASCS, ASIGPROPOSED resulted in 64% fewer TTE and 10% fewer RHC compared with ASIGSTANDARD , with $1936 (15%) saved for each case of PAH diagnosed. When the costs were extrapolated to the entire Australian SSc population, there was an estimated screening cost saving of $946 000 per annum with ASIGPROPOSED , with a cost saving of $851 400 in each subsequent year of screening.


CONCLUSIONS
ASIGPROPOSED substantially reduces the number of TTE and RHC required and results in substantial cost savings in SSc-PAH screening compared with ASIGSTANDARD .
Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
A
A
Quinlivan
Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Rheumatology, Liverpool Hospital, Sydney, New South Wales, Australia.|School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia.
V
V
Thakkar
Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
W
W
Stevens
Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
K
K
Morrisroe
Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
D
D
Prior
Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
C
C
Rabusa
Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
P
P
Youssef
The University of Notre Dame, Fremantle, Australia.
E
E
Gabbay
Department of Rheumatology, Royal Perth Hospital, Perth, Western Australia, Australia.
J
J
Roddy
Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia.
J G
JG
Walker
Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
J
J
Zochling
Department of Rheumatology, Monash University, Monash Health, Melbourne, Victoria, Australia.
J
J
Sahhar
Rheumatology Research Unit, Department of Medicine, University of Queensland, Sunshine Coast, Queensland, Australia.
P
P
Nash
Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
S
S
Lester
Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.|Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
M
M
Rischmueller
Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
S M
SM
Proudman
Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
M
M
Nikpour
D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D017046:Cost Savings / Q000379:methods*; D004452:Echocardiography / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000191:economics*; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012129:Respiratory Function Tests / Q000191:economics / Q000379:methods; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000191:economics*
algorithm; cost; pulmonary arterial hypertension; scleroderma; screening