Sandra Sanders-van Wijk1, Antoinette D I van Asselt2, Hans Rickli3, Werner Estlinbaum4, Paul Erne5, Peter Rickenbacher6, Andre Vuillomenet7, Martin Peter8, Matthias E Pfisterer9, Hans-Peter Brunner-La Rocca10. 1. Department of Cardiology, Maastricht University Medical Center, Cardiovascular Centre Maastricht, Maastricht, the Netherlands. Electronic address: Sandra.van.wijk@mumc.nl. 2. Department of Clinical Epidemiology, Maastricht University Medical Center, Maastricht, the Netherlands. 3. Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 4. Cardiology, University Hospital Liestal, Liestal, Switzerland. 5. Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland. 6. Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland. 7. Cardiology, Kantonsspital Aarau, Aarau, Switzerland. 8. Clinic of Internal Medicine, Kantonales Spital Wolhusen, Sursee, Switzerland. 9. Department of Cardiology, University Hospital Basel, Basel, Switzerland. 10. Department of Cardiology, Maastricht University Medical Center, Cardiovascular Centre Maastricht, Maastricht, the Netherlands; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Abstract
OBJECTIVES: This study aimed to assess cost-effectiveness of N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided versus symptom-guided therapy in heart failure (HF) patients≥60 years old. BACKGROUND:Cost-effectiveness of NT-proBNP guidance in HF patients is unclear. It may create additional costs with uncertain benefits. METHODS: In the TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure), patients with left ventricular ejection fraction (LVEF) of ≤45% were randomized to receive intensified NT-proBNP-guided therapy or standard, symptom-guided therapy. For cost-effectiveness analysis, 467 (94%) patients (age 76 ± 7 years, 66% male) were eligible. Incremental cost-effectiveness was calculated as incremental costs per gained life-year and quality-adjusted life-year (QALY) within the 18-month trial period, as defined per protocol. RESULTS:NT-proBNP-guided therapy was dominant (i.e., more effective and less costly) over symptom-guided therapy, saving $2,979 USD (2.5 to 97.5% confidence interval [CI]: $8,758 to $3,265) per patient, with incremental effectiveness of +0.07 life-years and +0.05 QALYs. The probability of NT-proBNP-guided therapy being dominant was 80%, and the probability of saving 1 life-year or QALY at a cost of $50,000 was 97% and 93%, respectively. Exclusion of residence costs resulted in an incremental cost-effectiveness ratio (ICER) of $5,870 per life-year gained. Cost-effectiveness of NT-proBNP-guided therapy was most pronounced in patients <75 years old and in those with <2 significant comorbidities, being dominant in all sensitivity analyses. In the worst-case scenario (excluding residence costs in those with ≥2 comorbidities), the ICER was $11,935 per life-year gained. CONCLUSIONS:NT-proBNP-guided therapy has a high probability of being cost effective in HF patients with reduced LVEF, particularly in patients age 60 to 75 years or with less than 2 comorbidities. (Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure [TIME-CHF]; ISRCTN43596477).
RCT Entities:
OBJECTIVES: This study aimed to assess cost-effectiveness of N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided versus symptom-guided therapy in heart failure (HF) patients ≥60 years old. BACKGROUND: Cost-effectiveness of NT-proBNP guidance in HF patients is unclear. It may create additional costs with uncertain benefits. METHODS: In the TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure), patients with left ventricular ejection fraction (LVEF) of ≤45% were randomized to receive intensified NT-proBNP-guided therapy or standard, symptom-guided therapy. For cost-effectiveness analysis, 467 (94%) patients (age 76 ± 7 years, 66% male) were eligible. Incremental cost-effectiveness was calculated as incremental costs per gained life-year and quality-adjusted life-year (QALY) within the 18-month trial period, as defined per protocol. RESULTS: NT-proBNP-guided therapy was dominant (i.e., more effective and less costly) over symptom-guided therapy, saving $2,979 USD (2.5 to 97.5% confidence interval [CI]: $8,758 to $3,265) per patient, with incremental effectiveness of +0.07 life-years and +0.05 QALYs. The probability of NT-proBNP-guided therapy being dominant was 80%, and the probability of saving 1 life-year or QALY at a cost of $50,000 was 97% and 93%, respectively. Exclusion of residence costs resulted in an incremental cost-effectiveness ratio (ICER) of $5,870 per life-year gained. Cost-effectiveness of NT-proBNP-guided therapy was most pronounced in patients <75 years old and in those with <2 significant comorbidities, being dominant in all sensitivity analyses. In the worst-case scenario (excluding residence costs in those with ≥2 comorbidities), the ICER was $11,935 per life-year gained. CONCLUSIONS: NT-proBNP-guided therapy has a high probability of being cost effective in HF patients with reduced LVEF, particularly in patients age 60 to 75 years or with less than 2 comorbidities. (Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure [TIME-CHF]; ISRCTN43596477).
Authors: Julie McLellan; Carl J Heneghan; Rafael Perera; Alison M Clements; Paul P Glasziou; Karen E Kearley; Nicola Pidduck; Nia W Roberts; Sally Tyndel; F Lucy Wright; Clare Bankhead Journal: Cochrane Database Syst Rev Date: 2016-12-22
Authors: Antonio Leon-Justel; Jose I Morgado Garcia-Polavieja; Ana Isabel Alvarez-Rios; Francisco Jose Caro Fernandez; Pedro Agustin Pajaro Merino; Elena Galvez Rios; Ignacio Vazquez-Rico; Jose Francisco Diaz Fernandez Journal: Health Qual Life Outcomes Date: 2021-05-08 Impact factor: 3.186
Authors: Syed Mohiuddin; Barnaby Reeves; Maria Pufulete; Rachel Maishman; Mark Dayer; John Macleod; Theresa McDonagh; Sarah Purdy; Chris Rogers; William Hollingworth Journal: BMJ Open Date: 2016-12-28 Impact factor: 2.692