Cost-effectiveness analysis of natriuretic peptide testing and specialist management in patients with suspected acute heart failure

Autor: Andrew Ludman, Martin R. Cowie, David Wonderling, Jonathan Mant, Jason Kendall, John J.V. McMurray, Abdallah Al-Mohammad, Edward A. Griffin, Katharina Dworzynski, Aminat Shote, Suzanna M C Hardman, Polly Mitchell
Přispěvatelé: Mant, Jonathan [0000-0002-9531-0268], Apollo - University of Cambridge Repository
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
Economics
Cost effectiveness
Cost-Benefit Analysis
specialist management
Psychological intervention
Social Sciences
030204 cardiovascular system & hematology
law.invention
0302 clinical medicine
Randomized controlled trial
law
Business & Economics
Ventricular Dysfunction
Medicine
030212 general & internal medicine
health care economics and organizations
Randomized Controlled Trials as Topic
Aged
80 and over
Health Policy
Cost-effectiveness analysis
Markov Chains
Hospitalization
Outreach
Models
Economic
Systematic review
1117 Public Health And Health Services
Acute Disease
Health Policy & Services
SURVIVAL
Female
Quality-Adjusted Life Years
Life Sciences & Biomedicine
medicine.medical_specialty
acute heart failure
Audit
DIAGNOSIS
MORBIDITY
03 medical and health sciences
Humans
Natriuretic Peptides
Intensive care medicine
cost-effectiveness
1402 Applied Economics
Aged
Heart Failure
Science & Technology
natriuretic peptide
business.industry
MORTALITY
Public Health
Environmental and Occupational Health
CARE
medicine.disease
EMERGENCY-DEPARTMENT
RANDOMIZED-TRIAL
Health Care Sciences & Services
Heart failure
business
ISSN: 1098-3015
Popis: Objectives:\ud 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.\ud \ud Methods:\ud 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.\ud \ud Results:\ud 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.\ud \ud Conclusions:\ud 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.
Databáze: OpenAIRE
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