Cost-Effectiveness Analysis of Natriuretic Peptide Testing and Specialist Management in Patients with Suspected Acute Heart Failure
To determine the cost-effectiveness of natriuretic peptide (NP) testing and specialist outreach in patients with acute heart failure (AHF) residing off the cardiology ward. We used a Markov model to estimate costs and quality-adjusted life-years (QALYs) for patients presenting to hospital with suspe...
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| Veröffentlicht in: | Value in health 2017-09, Vol.20 (8), p.1025-1033 |
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| creator | Griffin, Edward A. Wonderling, David Ludman, Andrew J. Al-Mohammad, Abdallah Cowie, Martin R. Hardman, Suzanna M.C. McMurray, John J.V. Kendall, Jason Mitchell, Polly Shote, Aminat Dworzynski, Katharina Mant, Jonathan |
| description | To determine the cost-effectiveness of natriuretic peptide (NP) testing and specialist outreach in patients with acute heart failure (AHF) residing off the cardiology ward.
We used a Markov model to estimate costs and quality-adjusted life-years (QALYs) for patients presenting to hospital with suspected AHF. We examined diagnostic workup with and without the NP test in suspected new cases, and we examined the impact of specialist heart failure outreach in all suspected cases. Inputs for the model were derived from systematic reviews, the UK national heart failure audit, randomized controlled trials, expert consensus from a National Institute for Health and Care Excellence guideline development group, and a national online survey. The main benefit from specialist care (cardiology ward and specialist outreach) was the increased likelihood of discharge on disease-modifying drugs for people with left ventricular systolic dysfunction, which improve mortality and reduce re-admissions due to worsened heart failure (associated with lower utility). Costs included diagnostic investigations, admissions, pharmacological therapy, and follow-up heart failure care.
NP testing and specialist outreach are both higher cost, higher QALY, cost-effective strategies (incremental cost-effectiveness ratios of £11,656 and £2,883 per QALY gained, respectively). Combining NP and specialist outreach is the most cost-effective strategy. This result was robust to both univariate deterministic and probabilistic sensitivity analyses.
NP testing for the diagnostic workup of new suspected AHF is cost-effective. The use of specialist heart failure outreach for inpatients with AHF residing off the cardiology ward is cost-effective. Both interventions will help improve outcomes for this high-risk group. |
| doi_str_mv | 10.1016/j.jval.2017.05.007 |
| format | Article |
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We used a Markov model to estimate costs and quality-adjusted life-years (QALYs) for patients presenting to hospital with suspected AHF. We examined diagnostic workup with and without the NP test in suspected new cases, and we examined the impact of specialist heart failure outreach in all suspected cases. Inputs for the model were derived from systematic reviews, the UK national heart failure audit, randomized controlled trials, expert consensus from a National Institute for Health and Care Excellence guideline development group, and a national online survey. The main benefit from specialist care (cardiology ward and specialist outreach) was the increased likelihood of discharge on disease-modifying drugs for people with left ventricular systolic dysfunction, which improve mortality and reduce re-admissions due to worsened heart failure (associated with lower utility). Costs included diagnostic investigations, admissions, pharmacological therapy, and follow-up heart failure care.
NP testing and specialist outreach are both higher cost, higher QALY, cost-effective strategies (incremental cost-effectiveness ratios of £11,656 and £2,883 per QALY gained, respectively). Combining NP and specialist outreach is the most cost-effective strategy. This result was robust to both univariate deterministic and probabilistic sensitivity analyses.
NP testing for the diagnostic workup of new suspected AHF is cost-effective. The use of specialist heart failure outreach for inpatients with AHF residing off the cardiology ward is cost-effective. Both interventions will help improve outcomes for this high-risk group.</description><identifier>ISSN: 1098-3015</identifier><identifier>EISSN: 1524-4733</identifier><identifier>DOI: 10.1016/j.jval.2017.05.007</identifier><identifier>PMID: 28964433</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Disease ; acute heart failure ; Aged ; Aged, 80 and over ; Cardiology ; Clinical outcomes ; Clinical trials ; Cost analysis ; Cost-Benefit Analysis ; cost-effectiveness ; Discharge ; Female ; Health care expenditures ; Heart diseases ; Heart failure ; Heart Failure - diagnosis ; Heart Failure - economics ; Heart Failure - therapy ; High risk ; Hospitalization ; Hospitalization - economics ; Humans ; Inpatient care ; Male ; Markov Chains ; Medical tests ; Models, Economic ; Mortality ; natriuretic peptide ; Natriuretic Peptides - blood ; Patient admissions ; Peptides ; Quality adjusted life years ; Randomized Controlled Trials as Topic ; Risk groups ; Sensitivity analysis ; specialist management ; Specialists ; Systematic review ; Ventricle ; Ventricular dysfunction ; Ventricular Dysfunction - economics ; Ventricular Dysfunction - mortality ; Ventricular Dysfunction - therapy</subject><ispartof>Value in health, 2017-09, Vol.20 (8), p.1025-1033</ispartof><rights>2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)</rights><rights>Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Sep 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-257504f31402ac7c765739b2653fbe3621c7b2e4075a501ef05c94dfa38b44d93</citedby><cites>FETCH-LOGICAL-c428t-257504f31402ac7c765739b2653fbe3621c7b2e4075a501ef05c94dfa38b44d93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jval.2017.05.007$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,30980,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28964433$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Griffin, Edward A.</creatorcontrib><creatorcontrib>Wonderling, David</creatorcontrib><creatorcontrib>Ludman, Andrew J.</creatorcontrib><creatorcontrib>Al-Mohammad, Abdallah</creatorcontrib><creatorcontrib>Cowie, Martin R.</creatorcontrib><creatorcontrib>Hardman, Suzanna M.C.</creatorcontrib><creatorcontrib>McMurray, John J.V.</creatorcontrib><creatorcontrib>Kendall, Jason</creatorcontrib><creatorcontrib>Mitchell, Polly</creatorcontrib><creatorcontrib>Shote, Aminat</creatorcontrib><creatorcontrib>Dworzynski, Katharina</creatorcontrib><creatorcontrib>Mant, Jonathan</creatorcontrib><title>Cost-Effectiveness Analysis of Natriuretic Peptide Testing and Specialist Management in Patients with Suspected Acute Heart Failure</title><title>Value in health</title><addtitle>Value Health</addtitle><description>To determine the cost-effectiveness of natriuretic peptide (NP) testing and specialist outreach in patients with acute heart failure (AHF) residing off the cardiology ward.
We used a Markov model to estimate costs and quality-adjusted life-years (QALYs) for patients presenting to hospital with suspected AHF. We examined diagnostic workup with and without the NP test in suspected new cases, and we examined the impact of specialist heart failure outreach in all suspected cases. Inputs for the model were derived from systematic reviews, the UK national heart failure audit, randomized controlled trials, expert consensus from a National Institute for Health and Care Excellence guideline development group, and a national online survey. The main benefit from specialist care (cardiology ward and specialist outreach) was the increased likelihood of discharge on disease-modifying drugs for people with left ventricular systolic dysfunction, which improve mortality and reduce re-admissions due to worsened heart failure (associated with lower utility). Costs included diagnostic investigations, admissions, pharmacological therapy, and follow-up heart failure care.
NP testing and specialist outreach are both higher cost, higher QALY, cost-effective strategies (incremental cost-effectiveness ratios of £11,656 and £2,883 per QALY gained, respectively). Combining NP and specialist outreach is the most cost-effective strategy. This result was robust to both univariate deterministic and probabilistic sensitivity analyses.
NP testing for the diagnostic workup of new suspected AHF is cost-effective. The use of specialist heart failure outreach for inpatients with AHF residing off the cardiology ward is cost-effective. Both interventions will help improve outcomes for this high-risk group.</description><subject>Acute Disease</subject><subject>acute heart failure</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiology</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>cost-effectiveness</subject><subject>Discharge</subject><subject>Female</subject><subject>Health care expenditures</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - economics</subject><subject>Heart Failure - therapy</subject><subject>High risk</subject><subject>Hospitalization</subject><subject>Hospitalization - economics</subject><subject>Humans</subject><subject>Inpatient care</subject><subject>Male</subject><subject>Markov Chains</subject><subject>Medical tests</subject><subject>Models, Economic</subject><subject>Mortality</subject><subject>natriuretic peptide</subject><subject>Natriuretic Peptides - blood</subject><subject>Patient admissions</subject><subject>Peptides</subject><subject>Quality adjusted life years</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk groups</subject><subject>Sensitivity analysis</subject><subject>specialist management</subject><subject>Specialists</subject><subject>Systematic review</subject><subject>Ventricle</subject><subject>Ventricular dysfunction</subject><subject>Ventricular Dysfunction - economics</subject><subject>Ventricular Dysfunction - mortality</subject><subject>Ventricular Dysfunction - therapy</subject><issn>1098-3015</issn><issn>1524-4733</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNp9kU1v1DAQhi1ERT_gD3BAlrhwSTr-ihOJy2rVL6lApZaz5TiT4iibLLazqGf-eL3awoEDp5nDM68070PIewYlA1adD-Wws2PJgekSVAmgX5ETprgspBbidd6hqQsBTB2T0xgHAKgEV2_IMa-bSkohTsjv9RxTcdH36JLf4YQx0tVkx6foI517-tWm4JeAyTt6h9vkO6QPGJOfHqmdOnq_Reft6GOiX-xkH3GDU6J-onc2-bxG-sunH_R-iRlM2NGVWxLSa7Qh0Uvrx5z9lhz1doz47mWeke-XFw_r6-L229XNenVbOMnrVHClFcheMAncOu10pbRoWl4p0bcoKs6cbjlK0MoqYNiDco3seivqVsquEWfk0yF3G-afS37CbHx0OI52wnmJhjVSaVY1XGX04z_oMC8h9xINh1pKJWqmM8UPlAtzjAF7sw1-Y8OTYWD2isxg9orMXpEBZbKifPThJXppN9j9PfnjJAOfDwDmLnYeg4kuV-mw8yF3aLrZ_y__Gc2nop4</recordid><startdate>201709</startdate><enddate>201709</enddate><creator>Griffin, Edward A.</creator><creator>Wonderling, David</creator><creator>Ludman, Andrew J.</creator><creator>Al-Mohammad, Abdallah</creator><creator>Cowie, Martin R.</creator><creator>Hardman, Suzanna M.C.</creator><creator>McMurray, John J.V.</creator><creator>Kendall, Jason</creator><creator>Mitchell, Polly</creator><creator>Shote, Aminat</creator><creator>Dworzynski, Katharina</creator><creator>Mant, Jonathan</creator><general>Elsevier Inc</general><general>Elsevier Science Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>201709</creationdate><title>Cost-Effectiveness Analysis of Natriuretic Peptide Testing and Specialist Management in Patients with Suspected Acute Heart Failure</title><author>Griffin, Edward A. ; Wonderling, David ; Ludman, Andrew J. ; Al-Mohammad, Abdallah ; Cowie, Martin R. ; Hardman, Suzanna M.C. ; McMurray, John J.V. ; Kendall, Jason ; Mitchell, Polly ; Shote, Aminat ; Dworzynski, Katharina ; Mant, Jonathan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-257504f31402ac7c765739b2653fbe3621c7b2e4075a501ef05c94dfa38b44d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute Disease</topic><topic>acute heart failure</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiology</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>cost-effectiveness</topic><topic>Discharge</topic><topic>Female</topic><topic>Health care expenditures</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - economics</topic><topic>Heart Failure - therapy</topic><topic>High risk</topic><topic>Hospitalization</topic><topic>Hospitalization - economics</topic><topic>Humans</topic><topic>Inpatient care</topic><topic>Male</topic><topic>Markov Chains</topic><topic>Medical tests</topic><topic>Models, Economic</topic><topic>Mortality</topic><topic>natriuretic peptide</topic><topic>Natriuretic Peptides - blood</topic><topic>Patient admissions</topic><topic>Peptides</topic><topic>Quality adjusted life years</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk groups</topic><topic>Sensitivity analysis</topic><topic>specialist management</topic><topic>Specialists</topic><topic>Systematic review</topic><topic>Ventricle</topic><topic>Ventricular dysfunction</topic><topic>Ventricular Dysfunction - economics</topic><topic>Ventricular Dysfunction - mortality</topic><topic>Ventricular Dysfunction - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Griffin, Edward A.</creatorcontrib><creatorcontrib>Wonderling, David</creatorcontrib><creatorcontrib>Ludman, Andrew J.</creatorcontrib><creatorcontrib>Al-Mohammad, Abdallah</creatorcontrib><creatorcontrib>Cowie, Martin R.</creatorcontrib><creatorcontrib>Hardman, Suzanna M.C.</creatorcontrib><creatorcontrib>McMurray, John J.V.</creatorcontrib><creatorcontrib>Kendall, Jason</creatorcontrib><creatorcontrib>Mitchell, Polly</creatorcontrib><creatorcontrib>Shote, Aminat</creatorcontrib><creatorcontrib>Dworzynski, Katharina</creatorcontrib><creatorcontrib>Mant, Jonathan</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>Value in health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Griffin, Edward A.</au><au>Wonderling, David</au><au>Ludman, Andrew J.</au><au>Al-Mohammad, Abdallah</au><au>Cowie, Martin R.</au><au>Hardman, Suzanna M.C.</au><au>McMurray, John J.V.</au><au>Kendall, Jason</au><au>Mitchell, Polly</au><au>Shote, Aminat</au><au>Dworzynski, Katharina</au><au>Mant, Jonathan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-Effectiveness Analysis of Natriuretic Peptide Testing and Specialist Management in Patients with Suspected Acute Heart Failure</atitle><jtitle>Value in health</jtitle><addtitle>Value Health</addtitle><date>2017-09</date><risdate>2017</risdate><volume>20</volume><issue>8</issue><spage>1025</spage><epage>1033</epage><pages>1025-1033</pages><issn>1098-3015</issn><eissn>1524-4733</eissn><abstract>To determine the cost-effectiveness of natriuretic peptide (NP) testing and specialist outreach in patients with acute heart failure (AHF) residing off the cardiology ward.
We used a Markov model to estimate costs and quality-adjusted life-years (QALYs) for patients presenting to hospital with suspected AHF. We examined diagnostic workup with and without the NP test in suspected new cases, and we examined the impact of specialist heart failure outreach in all suspected cases. Inputs for the model were derived from systematic reviews, the UK national heart failure audit, randomized controlled trials, expert consensus from a National Institute for Health and Care Excellence guideline development group, and a national online survey. The main benefit from specialist care (cardiology ward and specialist outreach) was the increased likelihood of discharge on disease-modifying drugs for people with left ventricular systolic dysfunction, which improve mortality and reduce re-admissions due to worsened heart failure (associated with lower utility). Costs included diagnostic investigations, admissions, pharmacological therapy, and follow-up heart failure care.
NP testing and specialist outreach are both higher cost, higher QALY, cost-effective strategies (incremental cost-effectiveness ratios of £11,656 and £2,883 per QALY gained, respectively). Combining NP and specialist outreach is the most cost-effective strategy. This result was robust to both univariate deterministic and probabilistic sensitivity analyses.
NP testing for the diagnostic workup of new suspected AHF is cost-effective. The use of specialist heart failure outreach for inpatients with AHF residing off the cardiology ward is cost-effective. Both interventions will help improve outcomes for this high-risk group.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28964433</pmid><doi>10.1016/j.jval.2017.05.007</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease acute heart failure Aged Aged, 80 and over Cardiology Clinical outcomes Clinical trials Cost analysis Cost-Benefit Analysis cost-effectiveness Discharge Female Health care expenditures Heart diseases Heart failure Heart Failure - diagnosis Heart Failure - economics Heart Failure - therapy High risk Hospitalization Hospitalization - economics Humans Inpatient care Male Markov Chains Medical tests Models, Economic Mortality natriuretic peptide Natriuretic Peptides - blood Patient admissions Peptides Quality adjusted life years Randomized Controlled Trials as Topic Risk groups Sensitivity analysis specialist management Specialists Systematic review Ventricle Ventricular dysfunction Ventricular Dysfunction - economics Ventricular Dysfunction - mortality Ventricular Dysfunction - therapy |
| title | Cost-Effectiveness Analysis of Natriuretic Peptide Testing and Specialist Management in Patients with Suspected Acute Heart Failure |
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