Key result
NT-proBNP point-of-care testing in general practice resulted in lower 1-year societal costs (€505 vs €543) and fewer delayed diagnoses (22% vs 38%) compared to clinical diagnosis alone.
Why the study?
Does NT-proBNP point-of-care testing reduce costs and diagnostic delay compared to clinical diagnosis alone or hospital laboratory testing in patients with suspected heart failure?
Does NT-proBNP point-of-care testing reduce costs and diagnostic delay compared to clinical diagnosis alone or hospital laboratory testing in patients with suspected heart failure?
Using NT-proBNP point-of-care testing in primary care for suspected heart failure yields earlier diagnoses and lower overall societal costs compared to clinical evaluation alone or hospital-based testing.
Answers are grounded in this paper and cite their sources.
POC NT-proBNP testing may lower costs and improve HF outcomes in primary care; modeling leaves open need for prospective validation.
BACKGROUND: Afflicting 1-2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition. AIM: The aim of this study was to estimate 1-year health outcome and costs of three diagnostic strategies: 1) history and clinical findings ('clinical diagnosis'); 2) clinical diagnosis supplemented with NTproBNP point-of-care test ('POC test') in the GP's surgery; or (3) in hospital laboratory ('hospital test'). DESIGN & SETTING: A decision tree model was developed to simulate 1-year patient courses with each strategy in Norway. METHOD: = 103). The costs were based on various Norwegian fee schedules. Sensitivity analyses were conducted to examine the uncertainty of the results. RESULTS: The 1-year per person societal costs were €543, €505, and €607 for clinical diagnosis, POC test, and hospital test, respectively. Even though POC entails higher laboratory costs, the total primary care costs were lower because of fewer re-visits with the GP and less use of spirometry. While 38% of patients had a delayed diagnosis with clinical diagnosis, the proportions were 22% with both POC test and hospital test. Results were most sensitive to the probability of use of spirometry. CONCLUSION: POC testing results in earlier diagnosis and lower costs than the other diagnostic modalities.
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Bugge et al. (2018) studied Heart failure. NT-proBNP point-of-care testing vs. Clinical diagnosis alone or hospital laboratory testing was evaluated on Proportion of initial incorrect diagnosis (delayed diagnosis). NT-proBNP point-of-care testing in general practice resulted in lower 1-year societal costs (€505 vs €543) and fewer delayed diagnoses (22% vs 38%) compared to clinical diagnosis alone.
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