Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study

Mark T Ledwidge, Eoin O'Connell, Joseph Gallagher, Lesley Tilson, Stephanie James, Victor Voon, Margaret Bermingham, Elaine Tallon, Chris Watson, Rory O'Hanlon, Michael Barry, Kenneth McDonald

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

AIMS: Prevention of cardiovascular disease and heart failure (HF) in a cost-effective manner is a public health goal. This work aims to assess the cost-effectiveness of the St Vincent's Screening TO Prevent Heart Failure (STOP-HF) intervention.

METHODS AND RESULTS: This is a substudy of 1054 participants with cardiovascular risk factors [median age 65.8 years, interquartile range (IQR) 57.8:72.4, with 4.3 years, IQR 3.4:5.2, follow-up]. Annual natriuretic peptide-based screening was performed, with collaborative cardiovascular care between specialist physicians and general practitioners provided to patients with BNP levels >50 pg/mL. Analysis of cost per case prevented and cost-effectiveness per quality-adjusted life year (QALY) gained was performed. The primary clinical endpoint of LV dysfunction (LVD) with or without HF was reduced in intervention patients [odds ratio (OR) 0.60; 95% confidence interval (CI) 0.38-0.94; P = 0.026]. There were 157 deaths and/or emergency hospitalizations for major adverse cardiac events (MACE) in the control group vs. 102 in the intervention group (OR 0.68; 95% CI 0.49-0.93; P = 0.01). The cost per case of LVD/HF prevented was €9683 (sensitivity range -€843 to €20 210), whereas the cost per MACE prevented was €3471 (sensitivity range -€302 to €7245). Cardiovascular hospitalization savings offset increased outpatient and primary care costs. The cost per QALY gain was €1104 and the intervention has an 88% probability of being cost-effective at a willingness to pay threshold of €30 000.

CONCLUSION: Among patients with cardiovascular risk factors, natriuretic peptide-based screening and collaborative care reduced LVD, HF, and MACE, and has a high probability of being cost-effective.

TRIAL REGISTRATION: NCT00921960.

Original languageEnglish
Pages (from-to)672-9
Number of pages8
JournalEuropean Journal of Heart Failure
Volume17
Issue number7
Early online date03 Jul 2015
DOIs
Publication statusPublished - Jul 2015

Keywords

  • Aged
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Heart Failure
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain
  • Patient Care Team
  • Prospective Studies
  • Quality-Adjusted Life Years
  • Risk Factors
  • Ventricular Dysfunction, Left

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