Evaluación económica de la determinación del propéptido natriurético cerebral n-terminal (NT-proBNP) en pacientes con disnea en los servicios de urgencias españoles

Abstract

IntroductionTo assess the efficiency of adding the NT-proBNP test to the standard clinical evaluation (SCE) for the diagnosis of heart failure (HF) in Spanish emergency department (ED) patients with dyspnea. Material and methodsA decision-tree was developed to evaluate the clinical and economic outcomes of the two diagnostic alternatives 60 days after ED admission in hospitalized and non-hospitalized patients. Clinical parameters were mainly extracted from the PRIDE study and were validated by expert ED physicians and cardiologists. The cut-off point for the NT-proBNP test was 900pg/mL (sensitivity of 90% and specificity of 85%). We assumed that 65% of patients with dyspnea had HF, based on published Spanish data. Resource use was obtained by expert opinion and evaluated from the public payer perspective (Spanish National Health Service (NHS)). The analysis compared the final diagnosis with the ED diagnosis. Multiple sensitivity analyses were carried out to evaluate the uncertainty of the model. ResultsThe diagnosis using NT-proBNP testing was correct in 91.96% of patients (59.09% true positive and 32.87% true negative) vs. 85.53% using SCE alone (50.79% true positive and 34.74% true negative). Costs were lower in patients receiving NT-proBNP testing (€3,720 versus €5,188). The sensitivity analyses confirmed the results. ConclusionsThe use of the NT-proBNP test for the assessment and management of Spanish emergency department patients with dyspnea is less costly and shows a higher percentage of correctly-diagnosed patients from the Spanish NHS perspective than SCE alone.