Cost-effectiveness of Screening with B-type Natriuretic Peptide to Identify Patients with Reduced Left Ventricular Ejection Fraction

Published in: Journal of the American College of Cardiology, v. 43, no. 6, Mar. 17, 2004, p. 1019-1026

Posted on RAND.org on December 31, 2003

by Paul Heidenreich, Matthew Gubens, Gregg C. Fonarow, Marvin A. Konstam, Lynne Warner Stevenson, Paul G. Shekelle

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OBJECTIVES: This study was designed to evaluate the cost-effectiveness of screening patients with a B-type natriuretic peptide (BNP) blood test to identify those with depressed left ventricular systolic function. BACKGROUND: Asymptomatic patients with depressed ejection fraction (EF) may have less progression to heart failure if they can be identified and treated. METHODS: The authors used a decision model to estimate economic and health outcomes for different screening strategies using BNP and echocardiography to detect left ventricular EF <40% for men and women age 60 years. The authors used published data from community cohorts (gender-specific BNP test characteristics, prevalence of depressed EF) and randomized trials (benefit from treatment). RESULTS: Screening 1,000 asymptomatic patients with BNP followed by echocardiography in those with an abnormal test increased the lifetime cost of care ($176,000 for men, $101,000 for women) and improved outcome (7.9 quality-adjusted life years [QALYs] for men, 1.3 QALYs for women), resulting in a cost per QALY of $22,300 for men and $77,700 for women. For populations with a prevalence of depressed EF of at least 1%, screening with BNP followed by echocardiography increased outcome at a cost <$50,000 per QALY gained. Screening would not be attractive if a diagnosis of left ventricular dysfunction led to significant decreases in quality of life or income. CONCLUSIONS: Screening populations with a 1% prevalence of reduced EF (men at age 60 years) with BNP followed by echocardiography should provide a health benefit at a cost that is comparable to or less than other accepted health interventions.

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