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Cost-effectiveness analysis of serial measurement of circulating natriuretic peptide concentration in chronic heart
Philippe Laramée1, David Wonderling, Sharon Swain
1National Clinical Guideline Centre, Royal College of Physicians, 11 Street Andrew's Place, Regent's Park, London, UK. plaramee@outlook.com
Insights
Serial natriuretic peptide (NP) measurement by specialists is a cost-effective strategy for managing chronic heart failure (CHF). However, this approach may be harmful and not cost-effective for patients over 75 years old.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Clinical Trial Analysis
Background:
- Chronic heart failure (CHF) poses a significant burden on healthcare systems.
- Optimizing medical therapy is crucial for improving patient outcomes and managing costs.
- Current monitoring strategies for CHF require evaluation for cost-effectiveness.
Purpose of the Study:
- To evaluate the cost-effectiveness of three distinct monitoring strategies for optimizing medical therapy in patients with chronic heart failure (CHF).
- To compare serial natriuretic peptide (NP) measurement by a specialist, clinical assessment by a specialist, and usual community care.
- To identify the most economically viable approach for managing CHF across different patient subgroups.
Main Methods:
- Analysis based on six randomized controlled trials.
- Cost assessment from a UK National Health Service (NHS) perspective, estimating lifetime patient costs.
- Health outcome measured using quality-adjusted life-years (QALYs).
Main Results:
- Serial NP measurement by specialists was the most cost-effective strategy for CHF due to left ventricular systolic dysfunction (LVSD), with an ICER of £3304.
- This strategy was also favored for all CHF patients (ICER £14,694 vs. clinical assessment) and those ≤75 years (ICER £2517 vs. usual care).
- However, for patients >75 years with CHF, serial NP measurement was dominated (less effective, more costly) by other strategies; specialist clinical assessment was cost-effective (ICER £11,508 vs. usual care).
Conclusions:
- Serial NP measurement by specialists is the most cost-effective strategy for CHF due to LVSD and for most CHF patients.
- This approach is particularly effective for patients ≤75 years.
- For patients >75 years with CHF, NP-guided treatment may be harmful and not cost-effective; specialist clinical assessment is preferred.
Objective:
To assess the cost-effectiveness of three monitoring strategies for optimising medical therapy in chronic heart failure (CHF).
Design:
This analysis was based on six randomised controlled trials. Costs were measured from a UK NHS perspective and estimated for patients' lifetime. The health outcome was the quality-adjusted life-year (QALY).
Setting:
Hospital and community.
Patients:
Patients with CHF.
Interventions:
Serial measurement of natriuretic peptide (NP) by a specialist, clinical assessment by a specialist, and usual care in the community.
Main Outcome Measures:
Costs, QALYs, and incremental cost-effectiveness ratio (ICER).
Results:
Serial NP measurement by a specialist was the most cost-effective option in patients with CHF due to left ventricular systolic dysfunction (LVSD), showing an ICER of £3304 compared with clinical assessment. Serial NP measurement by a specialist was strongly favoured in patients with CHF from any cause, for all patients (ICER of £14 694 compared with clinical assessment by a specialist) and for the age subgroup ≤75 years (ICER of £2517 compared with usual care). However, serial NP measurement by a specialist was dominated (less effective and more costly) by alternative strategies in the subgroup age >75 years with CHF from any cause. Clinical assessment by a specialist of patients >75 years of age with CHF from any cause was cost-effective compared with usual care (ICER of £11 508).
Conclusions:
Serial measurement of NP concentration by a specialist is the most cost-effective strategy for CHF due to LVSD and from any cause, except in the subgroup of patients >75 years with CHF from any cause, where treatment guided by NP measurement may be harmful and not cost-effective.
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