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A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution

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A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution. / Webb, Jessica; Draper, Jane; Rua, Tiago Duarte De Oliveira et al.

In: International Journal of Cardiology, Vol. 257, 15.04.2018, p. 131-136.

Research output: Contribution to journalArticlepeer-review

Harvard

Webb, J, Draper, J, Rua, TDDO, Yiu, Y, piper, S, Teall, T, Fovargue, LE, Bolca, E, Jackson, TA, Claridge, S, Sieniewicz, B, Porter, BR, McDiarmid, A, Rajani, R, Kapetanakis, S, Rinaldi, CA, Razavi, R, McDonagh, TA & Carr-White, G 2018, 'A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution', International Journal of Cardiology, vol. 257, pp. 131-136. https://doi.org/10.1016/j.ijcard.2017.10.126

APA

Webb, J., Draper, J., Rua, T. D. D. O., Yiu, Y., piper, S., Teall, T., Fovargue, L. E., Bolca, E., Jackson, T. A., Claridge, S., Sieniewicz, B., Porter, B. R., McDiarmid, A., Rajani, R., Kapetanakis, S., Rinaldi, C. A., Razavi, R., McDonagh, T. A., & Carr-White, G. (2018). A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution. International Journal of Cardiology, 257, 131-136. https://doi.org/10.1016/j.ijcard.2017.10.126

Vancouver

Webb J, Draper J, Rua TDDO, Yiu Y, piper S, Teall T et al. A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution. International Journal of Cardiology. 2018 Apr 15;257:131-136. https://doi.org/10.1016/j.ijcard.2017.10.126

Author

Webb, Jessica ; Draper, Jane ; Rua, Tiago Duarte De Oliveira et al. / A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution. In: International Journal of Cardiology. 2018 ; Vol. 257. pp. 131-136.

Bibtex Download

@article{ebd8c6c9caf8499194289c0a428d6c04,
title = "A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution",
abstract = "AimsThe 2014 National Institute of Clinical Excellence (NICE) guidelines on the management of acute heart failure recommended using a plasma NT-proBNP threshold of 300pm/ml to assist in ruling out the diagnosis of heart failure (HF), updating previous guidelines recommending using a threshold of 400pg/ml. NICE based their recommendations on 6 studies performed in other countries. This study sought to determine the diagnostic and economic implications of using these thresholds in a large unselected UK population. Methods Patient and clinical demographics were recorded for all consecutive suspected HF patients over 12 months, as well as clinical outcomes including time to HF hospitalisation and time to death (follow up 15.8 months). ResultsOf 1995 unselected patients admitted with clinically suspected HF, 1683 (84%) had a NTproBNP over the current NICE recommended threshold, of which 35% received a final diagnosis of HF. Lowering the threshold from 400 to 300pg/ml would have involved screening an additional 61 patients and only would have identified one new patient with HF (sensitivity 0.985, NPV 0.976, Area under the curve (AUC) at 300pg/ml 0.67; sensitivity 0.983, NPV 0.977, AUC 0.65 at 400pg/ml). The economic implications of lowering the threshold would have involved additional costs of £42,842.04 (£702.33 per patient screened, or £ 42,824.04 per new HF patient). ConclusionApplying the recent updated NICE guidelines to an unselected real world population increases the AUC but would have a significant economic impact and only identified one new patient with heart failure. ",
author = "Jessica Webb and Jane Draper and Rua, {Tiago Duarte De Oliveira} and Yee Yiu and susan piper and Thomas Teall and Fovargue, {Lauren Elin} and Elena Bolca and Jackson, {Thomas Andrew} and Simon Claridge and Benjamin Sieniewicz and Porter, {Bradley Robert} and Adam McDiarmid and Ronak Rajani and Stamatis Kapetanakis and Rinaldi, {Christopher A.} and Reza Razavi and McDonagh, {Theresa A.} and Gerald Carr-White",
year = "2018",
month = apr,
day = "15",
doi = "10.1016/j.ijcard.2017.10.126",
language = "English",
volume = "257",
pages = "131--136",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution

AU - Webb, Jessica

AU - Draper, Jane

AU - Rua, Tiago Duarte De Oliveira

AU - Yiu, Yee

AU - piper, susan

AU - Teall, Thomas

AU - Fovargue, Lauren Elin

AU - Bolca, Elena

AU - Jackson, Thomas Andrew

AU - Claridge, Simon

AU - Sieniewicz, Benjamin

AU - Porter, Bradley Robert

AU - McDiarmid, Adam

AU - Rajani, Ronak

AU - Kapetanakis, Stamatis

AU - Rinaldi, Christopher A.

AU - Razavi, Reza

AU - McDonagh, Theresa A.

AU - Carr-White, Gerald

PY - 2018/4/15

Y1 - 2018/4/15

N2 - AimsThe 2014 National Institute of Clinical Excellence (NICE) guidelines on the management of acute heart failure recommended using a plasma NT-proBNP threshold of 300pm/ml to assist in ruling out the diagnosis of heart failure (HF), updating previous guidelines recommending using a threshold of 400pg/ml. NICE based their recommendations on 6 studies performed in other countries. This study sought to determine the diagnostic and economic implications of using these thresholds in a large unselected UK population. Methods Patient and clinical demographics were recorded for all consecutive suspected HF patients over 12 months, as well as clinical outcomes including time to HF hospitalisation and time to death (follow up 15.8 months). ResultsOf 1995 unselected patients admitted with clinically suspected HF, 1683 (84%) had a NTproBNP over the current NICE recommended threshold, of which 35% received a final diagnosis of HF. Lowering the threshold from 400 to 300pg/ml would have involved screening an additional 61 patients and only would have identified one new patient with HF (sensitivity 0.985, NPV 0.976, Area under the curve (AUC) at 300pg/ml 0.67; sensitivity 0.983, NPV 0.977, AUC 0.65 at 400pg/ml). The economic implications of lowering the threshold would have involved additional costs of £42,842.04 (£702.33 per patient screened, or £ 42,824.04 per new HF patient). ConclusionApplying the recent updated NICE guidelines to an unselected real world population increases the AUC but would have a significant economic impact and only identified one new patient with heart failure.

AB - AimsThe 2014 National Institute of Clinical Excellence (NICE) guidelines on the management of acute heart failure recommended using a plasma NT-proBNP threshold of 300pm/ml to assist in ruling out the diagnosis of heart failure (HF), updating previous guidelines recommending using a threshold of 400pg/ml. NICE based their recommendations on 6 studies performed in other countries. This study sought to determine the diagnostic and economic implications of using these thresholds in a large unselected UK population. Methods Patient and clinical demographics were recorded for all consecutive suspected HF patients over 12 months, as well as clinical outcomes including time to HF hospitalisation and time to death (follow up 15.8 months). ResultsOf 1995 unselected patients admitted with clinically suspected HF, 1683 (84%) had a NTproBNP over the current NICE recommended threshold, of which 35% received a final diagnosis of HF. Lowering the threshold from 400 to 300pg/ml would have involved screening an additional 61 patients and only would have identified one new patient with HF (sensitivity 0.985, NPV 0.976, Area under the curve (AUC) at 300pg/ml 0.67; sensitivity 0.983, NPV 0.977, AUC 0.65 at 400pg/ml). The economic implications of lowering the threshold would have involved additional costs of £42,842.04 (£702.33 per patient screened, or £ 42,824.04 per new HF patient). ConclusionApplying the recent updated NICE guidelines to an unselected real world population increases the AUC but would have a significant economic impact and only identified one new patient with heart failure.

UR - http://www.scopus.com/inward/record.url?scp=85042862886&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2017.10.126

DO - 10.1016/j.ijcard.2017.10.126

M3 - Article

VL - 257

SP - 131

EP - 136

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -

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