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CLINICAL RESEARCH: HEART FAILURE/TRANSPLANTATION

Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction

Paul A. Heidenreich, MD, MS^*,*, Matthew A. Gubens, MS, Gregg C. Fonarow, MD, Marvin A. Konstam, MD, Lynne W. Stevenson, MD^|| and Paul G. Shekelle, MD, PhD^¶

^* VA Palo Alto Health Care System, Palo Alto, California, USA
Stanford University School of Medicine, Stanford, California, USA
University of California at Los Angeles School of Medicine, Los Angeles, California, USA
Tufts-New England Medical Center, Boston, Massachusetts, USA
^|| Brigham and Women's Hospital, Boston, Massachusetts, USA
^¶ Greater Los Angeles VA Healthcare System, Los Angeles, California, USA

Manuscript received September 12, 2003; accepted October 15, 2003.

^* Reprint requests and correspondence: Dr. Paul A. Heidenreich, 111C Cardiology, Palo Alto VAMC, 3801 Miranda Avenue, Palo Alto, California 94034, USA.
heiden{at}stanford.edu

OBJECTIVES: This study was designed to evaluate the cost-effectiveness of screening patients with a B-type natriuretic peptide (BNP) blood test to identify those with depressed left ventricular systolic function.

BACKGROUND: Asymptomatic patients with depressed ejection fraction (EF) may have less progression to heart failure if they can be identified and treated.

METHODS: We used a decision model to estimate economic and health outcomes for different screening strategies using BNP and echocardiography to detect left ventricular EF <40% for men and women age 60 years. We used published data from community cohorts (gender-specific BNP test characteristics, prevalence of depressed EF) and randomized trials (benefit from treatment).

RESULTS: Screening 1,000 asymptomatic patients with BNP followed by echocardiography in those with an abnormal test increased the lifetime cost of care ($176,000 for men, $101,000 for women) and improved outcome (7.9 quality-adjusted life years [QALYs] for men, 1.3 QALYs for women), resulting in a cost per QALY of $22,300 for men and $77,700 for women. For populations with a prevalence of depressed EF of at least 1%, screening with BNP followed by echocardiography increased outcome at a cost <$50,000 per QALY gained. Screening would not be attractive if a diagnosis of left ventricular dysfunction led to significant decreases in quality of life or income.

CONCLUSIONS: Screening populations with a 1% prevalence of reduced EF (men at age 60 years) with BNP followed by echocardiography should provide a health benefit at a cost that is comparable to or less than other accepted health interventions.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   BNP = B-type natriuretic peptide   ECG = electrocardiogram   EF = ejection fraction   HF = heart failure   LV = left ventricular   QALY = quality-adjusted life year   SOLVD = Studies Of Left Ventricular Dysfunction

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