Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study

• Main Authors: Christoffer Bugge, Erik Magnus Sether, Andreas Pahle, Sigrun Halvorsen, Ivar Sonbo Kristiansen
• Format: Article
• Language: English
• Published: Royal College of General Practitioners 2018-07-01
• Series: BJGP Open
• Subjects: Heart failure; NT-proBNP; primary health care; general practice; point of care
• Online Access: https://bjgpopen.org/content/2/3/bjgpopen18X101596

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: Sensitivity and specificity of clinical diagnosis (56% and 68%), and of N-terminal pro B-type natriuretic peptide test ([NT-proBNP] 90% and 65%), were based on published literature. The probabilities of referral to hospital were based on a survey of Norwegian GPs (n = 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.