Abstract
BackgroundB-type natriuretic peptide (BNP) is commonly used as a diagnostic method for patients with heart failure. This study was designed to evaluate the cost-effectiveness of BNP compared to standard clinical assessment in outpatients with heart failure with reduced ejection fraction (HFrEF) in Tehran, Iran.MethodsThis study was a cost-effectiveness analysis carried on 400 HFrEF outpatients > 45 years who were admitted to Rasoul Akram General Hospital of Tehran, Iran. A Markov model with a lifetime horizon was developed to evaluate economic and clinical outcomes for BNP and standard clinical assessment. Quality-adjusted life-years (QALYs), direct, and indirect costs collected from the patients.ResultsThe results of this study indicated that mean QALYs and cost were estimated to be 2.18 QALYs and $1835 for BNP and 2.07 and $2376 for standard clinical assessment, respectively. In terms of reducing costs and increasing QALYs, BNP was dominant compared to standard clinical assessment. Also, BNP had an 85% probability of being cost-effective versus standard clinical assessment if the willingness to pay threshold is higher than $20,800/QALY gained.ConclusionBased on the results of the present study, measuring BNP levels represents good value for money, decreasing costs and increasing QALYs compared to standard clinical assessment. It is suggested that the costs of the BNP test be covered by insurance in Iran. The result of the current study has important implications for policymakers in developing clinical guidelines for the diagnosis of heart failure.
Highlights
B-type natriuretic peptide (BNP) is commonly used as a diagnostic method for patients with heart failure
The results showed that the mean cost of BNP and standard clinical assessment were $682 and $649, respectively, in which the highest and lowest mean costs per patient were the direct medical costs and direct non-medical costs
The major costs in BNP and standard clinical assessments were related to the costs of medications used ($255 and $196, respectively) and diagnostic tests ($189 and $141, respectively) (Additional file 1)
Summary
B-type natriuretic peptide (BNP) is commonly used as a diagnostic method for patients with heart failure. This study was designed to evaluate the cost-effectiveness of BNP compared to standard clinical assessment in outpatients with heart failure with reduced ejection fraction (HFrEF) in Tehran, Iran. In Iran, 79% of deaths related to chronic diseases are attributed to cardiovascular disease [8,9,10,11]. Based on the guideline for the management of chronic heart failure in Iran, heart failure is confirmed by obtaining an accurate and complete medical history, clinical examination, and diagnostic tests. For all patients with heart failure with an ejection fraction less than 40%, Renin-angiotensin system inhibitor, in addition to beta-blocker, is recommended to reduce hospitalization due to heart failure or premature death. An electrocardiogram (ECG) is advised to detect heart rhythm, heart rate, and other related disorders [18]
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