MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care

Mark Monahan, Pelham Barton, Clare J Taylor, Andrea K Roalfe, F.D. Richard Hobbs, Martin Cowie, Russell Davis, Jon Deeks, Jonathan Mant, Deborah McCahon, Theresa McDonagh, George Sutton, Lynda Tait

    Research output: Contribution to journalArticlepeer-review

    11 Citations (Scopus)

    Abstract

    Background Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. Design A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. Methods Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. Results The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a “do nothing” strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥ 400 pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. Conclusions This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection.
    Original languageEnglish
    JournalInternational Journal of Cardiology
    Early online date2 Mar 2017
    DOIs
    Publication statusE-pub ahead of print - 2 Mar 2017

    Keywords

    • Medical economics
    • Economic model
    • Cost benefit analysis
    • Natriuretic peptide
    • General practice

    Fingerprint

    Dive into the research topics of 'MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care'. Together they form a unique fingerprint.

    Cite this