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COST-UTILITY ANALYSIS OF NT-PROBNP-GUIDED MULTIDISCIPLINARY CARE IN CHRONIC HEART FAILURE

Published online by Cambridge University Press:  20 December 2012

Deddo Moertl ,
Sabine Steiner ,
Doug Coyle  and
Rudolf Berger
Deddo Moertl
Affiliation:
Department of Internal Medicine III (Cardiology and Emergency Medicine), Landesklinikum St. Poelten, St. Poelten, Austria; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
Sabine Steiner
Affiliation:
Department of Internal Medicine II, Division of Vascular Medicine, Medical University of Vienna, Vienna, Austria; Prevention and Rehabilitation Centre, Heart Institute, University of Ottawa, Ottawa, Canada
Doug Coyle
Affiliation:
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
Rudolf Berger
Affiliation:
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Abstract

Objectives: A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective.

Methods: Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality.

Results: BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000.

Conclusions: NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.

Keywords

Cost-effectivenessHeart failureNatriuretic peptidesDisease management programsMarkov model
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 1 , January 2013 , pp. 3 - 11
Copyright
Copyright © Cambridge University Press 2012

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References

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