Estimation of the possible economic effects of a sequential testing strategy with NT-proBNP before echocardiography in primary care

Banafsheh Seyyed Khezri1, Johanna Helmersson-Karlqvist1, Anders Larsson1,*

1Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Introduction: Many of the symptoms of heart failure (HF) are non-specific and do not clearly distinguish between HF and other diseases. The echocardiogram and electrocardiogram are considered as the best tests in patients with suspected HF. The drawback with the echocardiography is that it is comparably expensive and the time from a primary care request to test result is often several weeks. Echocardiographies are also often negative which is due to the non-specific signs of HF, which causes referrals of many patients without HF. NT-proBNP  has therefore been used as a rule-out test for HF prior to echocardiogram.

Objectives: The aim of the study was to use cost-minimization analysis to assess the cost-effectiveness of using NT-proBNP in a sequential testing strategy to minimize the demand for echocardiographies in primary care patients. We used patient data from primary care patients in the county of Uppland to calculate the cost for a negative NT-proBNP result (rule out) and compared this with the cost of an echocardiography. 

Methods: The study data were collected from primary care physicians in the County of Uppland during 2005 to 2012. Two different cut-off levels for negative NT-proBNP in the rule-out test were used: 300 and 400 pg/mL. The cost-effectiveness of the testing strategy was estimated through the short-term cost avoidance and reduction in demand for echocardiographies.

Results: The female patients were slightly older than the males. Based on the data from 2012 the estimated costs for NT-proBNP tests and echocardiographies per county were reduced by EUR 300000/100000 inhabitants with the 300 pg/mL cut-off and EUR 350000/100000 inhabitants with the 400 pg/mL.

Conclusion: The use of NT-proBNP as a rule-out test in a sequential testing strategy reduced the cost for diagnostic work-up of primary care patients with suspected heart failure.

Keywords: Cardiovascular