Comparative cost-effectiveness of B-type natriuretic peptide and echocardiography for predicting outcome in patients
Hisham Dokainish1, William A Zoghbi, Eunice Ambriz
1Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA. hishamd@bcm.tmc.edu
Insights
B-type natriuretic peptide (BNP) testing is more cost-effective than Doppler echocardiography for predicting adverse outcomes in congestive heart failure (CHF) patients. BNP offers a more economical approach to identifying patients at risk of cardiac death or rehospitalization.
Area of Science:
- Cardiology
- Medical Diagnostics
- Health Economics
Background:
- Predicting outcomes in congestive heart failure (CHF) is crucial for patient management.
- Two-dimensional echocardiography, Doppler variables, and B-type natriuretic peptide (BNP) are known prognostic indicators.
- Limited data exists on the comparative cost-effectiveness of these predictive modalities.
Purpose of the Study:
- To evaluate the cost-effectiveness of Doppler echocardiography versus BNP in predicting cardiac death or rehospitalization for CHF.
- To compare the predictive accuracy and economic value of these diagnostic tools.
Main Methods:
- 116 hospitalized CHF patients underwent simultaneous BNP and Doppler echocardiographic assessments before discharge.
- Primary endpoint: cardiac death or CHF rehospitalization.
- Cost-effectiveness ratios (CER) were calculated for 2D variables, Doppler indexes, and BNP.
Main Results:
- 54 patients (50%) reached the primary endpoint over a mean follow-up of 527 days.
- Doppler echocardiography, with prior CHF hospitalization history, predicted 52/54 events (CER $729.10).
- BNP predicted 47/54 events with a significantly lower CER of $49.98 (p < 0.001).
Conclusions:
- Predischarge BNP testing is more cost-effective than comprehensive Doppler echocardiography for predicting future cardiac events in hospitalized CHF patients.
- BNP provides a valuable and economical tool for risk stratification in CHF management.
- This finding supports the integration of BNP testing into routine CHF care for improved resource allocation.
Abstract:
Two-dimensional echocardiographic and Doppler variables and B-type natriuretic peptide (BNP) can predict outcomes in patients with congestive heart failure (CHF). However, there is a paucity of data on the relative cost-effectiveness of these modalities in predicting outcome. One hundred sixteen patients hospitalized with CHF underwent simultaneous BNP and Doppler echocardiographic examinations once ready for discharge. The ability of these variables to determine the primary end point (cardiac death or rehospitalization for CHF) was determined. The cost-effectiveness ratios (CER) of 2-dimensional variables, Doppler indexes, and BNP were calculated for prediction of the primary end point. Follow-up was completed in 110 of 116 patients at a mean of 527 days after hospital discharge. Fifty-four patients (50%) reached the primary end point (37 rehospitalizations for CHF and 17 cardiac deaths). When added to a history of admission to the hospital in the preceding year for CHF, a comprehensive Doppler echocardiographic study predicted 52 of 54 events, with a CER of 729.10 dollars, whereas BNP predicted 47 of 54 events (CER 49.98 dollars; p < 0.001 for CER comparison). In patients admitted to hospitals with CHF, predischarge BNP is more cost-effective than comprehensive Doppler echocardiographic examination for the prediction of future cardiac death or rehospitalization for CHF.
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