The NICE diagnostic threshold (NT-proBNP ≥400 pg/mL) was associated with lower healthcare costs and similar QALYs compared with the ESC threshold (≥125 pg/mL) for suspected heart failure.
Does the NICE NT-proBNP threshold (≥400 pg/mL) improve cost-effectiveness compared to the ESC threshold (≥125 pg/mL) or universal echocardiography for suspected heart failure in primary care?
The NICE NT-proBNP threshold of ≥400 pg/mL for echocardiography referral in suspected heart failure provides an efficient balance of case detection and healthcare resource use compared to the lower ESC threshold.
Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a key test in primary care to inform which people with possible heart failure (HF) are referred for specialist assessment and echocardiography. However, the impact of alternative NT-proBNP diagnostic thresholds on healthcare use, costs and patient outcomes remains uncertain. Methods We conducted a cost-effectiveness analysis of three diagnostic strategies for suspected HF in UK primary care: echocardiography for all, the European Society of Cardiology (ESC) strategy (NT-proBNP ≥125 pg/mL) and the National Institute for Health and Care Excellence (NICE) strategy (NT-proBNP ≥400 pg/mL). An updated decision-analytical model informed by the prospective REFerral for EchocaRdiogram (REFER) primary care cohort incorporated contemporary HF therapies and included patients with preserved ejection fraction. Analyses adopted a UK National Health Service perspective over a lifetime horizon. Costs and quality-adjusted life-years (QALYs) were discounted at 3.5% annually. Deterministic and scenario sensitivity analyses were undertaken to assess structural and parameter uncertainty. Results In the base-case, the NICE threshold (≥400 pg/mL) was associated with lower healthcare costs and similar QALYs compared with the ESC threshold (≥125 pg/mL). The lower threshold increased detection of HF but substantially increased investigations among patients without HF. Results were robust across most sensitivity analyses. Under a scenario assuming universal diuretic use among treated patients, ESC and echocardiography for all strategies generated additional QALYs at modest extra cost compared with NICE. Conclusion For patients with suspected HF in primary care, the NICE diagnostic threshold represents an efficient balance between case detection and healthcare resource use. Cost-effectiveness of lower thresholds is sensitive to assumptions regarding downstream treatment patterns, highlighting the importance of real-world prescribing when evaluating diagnostic strategies.
Png et al. (Fri,) conducted a other in Suspected heart failure. NICE strategy (NT-proBNP ≥400 pg/mL) vs. ESC strategy (NT-proBNP ≥125 pg/mL) and echocardiography for all was evaluated on Healthcare costs and quality-adjusted life-years (QALYs). The NICE diagnostic threshold (NT-proBNP ≥400 pg/mL) was associated with lower healthcare costs and similar QALYs compared with the ESC threshold (≥125 pg/mL) for suspected heart failure.
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