PMID- 37781889
OWN - NLM
STAT- MEDLINE
DCOM- 20231102
LR  - 20231102
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 26
IP  - 1
DP  - 2023 Jan-Dec
TI  - Cost-effectiveness of NT-proBNP-supported screening of chronic heart failure in 
      patients with or without type 2 diabetes in Austria and Switzerland.
PG  - 1287-1300
LID - 10.1080/13696998.2023.2264722 [doi]
AB  - BACKGROUND: Heart failure (HF) is a clinical syndrome with a global burden. Signs 
      and symptoms of HF are nonspecific and often shared with other conditions. The 
      N-terminal prohormone of brain natriuretic peptide (NT-proBNP) serves as a useful 
      biomarker for the diagnosis of HF not only in patients with acute symptoms but 
      also in outpatients with an ambiguous clinical presentation. The aim of the 
      analysis is to evaluate the cost-effectiveness of implementing NT-proBNP in the 
      diagnostic algorithm in patients with/without type 2 diabetes mellitus (T2DM), 
      compared with a diagnosis based primarily on clinical signs or symptoms from the 
      perspective of the Austrian and Swiss healthcare system. METHODS: A time-discrete 
      Markov model was developed to simulate the effect/improvement (lifetime-costs, 
      quality-adjusted life-years [QALYs], and life-years [LYs]) due to an NT-proBNP 
      screening in undetected HF patients. Undetected HF patients are included in the 
      model according to a distribution of New York Heart Association (NYHA) classes. 
      The model considers disease progression by transition of NYHA classes. Undetected 
      patients may remain undetected or be detected with the help of NT-proBNP or 
      symptoms. Patients with known HF exhibit a slower disease progression. The 
      probability of dying is influenced by the respective NYHA class. Direct costs 
      (2021 euro or CHF) were derived from published sources. QALYs, LYs, and costs were 
      discounted (3% p.a.). RESULTS: In the per-patient analysis (at age 60 over 
      lifetime), the incremental cost-utility ratio (ICUR)/QALY of NT-proBNP vs. no 
      screening was euro3,042 for HF patients in Austria. Considering the total cohort of 
      undetected HF patients (n = 9,377) with the corresponding age structure over a 
      lifetime, the ICUR increases to euro4,356. In Switzerland, the per-patient results 
      show an ICUR of CHF 897. Considering the total cohort of undetected HF patients 
      (n = 6,826) the ICUR amounts to CHF 4,513. If indirect costs are considered, 
      NT-proBNP screening becomes the dominant strategy in both countries. CONCLUSION: 
      Overall, the analysis concludes that screening with NT-proBNP is a highly 
      cost-effective or cost-saving diagnostic option for patients with HF, and a 
      sensitivity analysis confirmed these findings.
FAU - Walter, Evelyn
AU  - Walter E
AD  - IPF Institute for Pharmaeconomic Research, Vienna, Austria.
FAU - Arrigo, Mattia
AU  - Arrigo M
AD  - Department of Internal Medicine, Stadtspital Zurich Triemli, Zurich, Switzerland.
FAU - Allerstorfer, Sigrid
AU  - Allerstorfer S
AD  - Roche Diagnostics GmbH, Vienna, Austria.
FAU - Marty, Petra
AU  - Marty P
AD  - Roche Diagnostics (Switzerland) AG, Rotkreuz, Switzerland.
FAU - Hulsmann, Martin
AU  - Hulsmann M
AD  - Department of Internal Medicine II, Medical University of Vienna, Vienna, 
      Austria.
LA  - eng
PT  - Journal Article
DEP - 20231018
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 0 (Biomarkers)
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain
MH  - Cost-Benefit Analysis
MH  - Austria
MH  - Switzerland
MH  - *Diabetes Mellitus, Type 2/complications
MH  - *Heart Failure/diagnosis
MH  - Biomarkers
MH  - Chronic Disease
MH  - Disease Progression
OTO - NOTNLM
OT  - C60
OT  - D04
OT  - Heart failure
OT  - I10
OT  - I11
OT  - NT-proBNP
OT  - NYHA
OT  - cost-effectiveness analysis
OT  - modeling
OT  - type 2 diabetes mellitus
EDAT- 2023/10/02 06:42
MHDA- 2023/10/02 06:43
CRDT- 2023/10/02 05:52
PHST- 2023/10/02 06:43 [medline]
PHST- 2023/10/02 06:42 [pubmed]
PHST- 2023/10/02 05:52 [entrez]
AID - 10.1080/13696998.2023.2264722 [doi]
PST - ppublish
SO  - J Med Econ. 2023 Jan-Dec;26(1):1287-1300. doi: 10.1080/13696998.2023.2264722. 
      Epub 2023 Oct 18.