King's College London

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 -