Economic Evaluation of NT-proBNP Supported Guideline-Directed Medical Therapy in Discharged Patients With Heart Failure in China

Speaker(s)

Liwen L1, Ailan C2, Shuang X1, Yue Z3, Xuan J4
1Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences,, Guangzhou, Guangdong, China, 2The First Affiliated Hospital of Guangzhou Medical Universit, Guangzhou, Guangdong, China, 3Roche Diagnostics (Shanghai) Limited, Shanghai, 31, China, 4Health Economic Research Institute, School of Pharmacy, Sun Yat-Sen University, Guangzhou, Guangdong, China

Presentation Documents

BACKGROUND:Heart failure (HF) is a prevalent and costly condition in China, particularly in cases of acute HF, resulting in a high readmission rate exceeding 40% within one year. Chinese HF patients have limited follow-up and suboptimal use of guideline-directed medical therapy (GDMT). The STRONG-HF trial demonstrated that intensified follow-up visits with monitored N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations, guiding rapid up-titration of medications, reduced all cause death or HF readmission by 34% within 180 days. However, the economic impact of this approach in the Chinese context remains unknown.

OBJECTIVES: To evaluate the extent to which the higher costs associated with up-titration of HF GDMT can be offset by the avoidance of HF readmissions within 180 days after discharge.

METHODS: A cost analysis was performed using a within-trial analysis and a decision-tree model to compare total medical cost of high-intensity care and usual care patients after discharge within 180 days. High-intensity care involved visits at 1, 2, 3, 6 weeks, 90 and 180 days, while usual care included visits at 90 and 180 days. The study population, usual care, local implementation, and treatment effects align with the STRONG-HF study. Cost inputs, including NT-proBNP and other lab testing costs, physician visit costs, drug costs, and HF readmission costs, were derived from published literature or public local databases. Uncertainties were assessed through deterministic sensitivity analyses (DSA).

RESULTS: Compared with usual care, high-intensity care of GDMT reduced all-cause death or HF readmission by 34% and decreased total medical cost per capita by 14% from 7,788.7 CNY to 6,672.8 CNY as well. Despite the increased costs associated with lab testing (1,163.8CNY) and medication (626.1CNY) for high-intensity care, these were offset by the decreased readmission cost of 2,968.9 CNY. DSA confirmed the robustness of the results.

CONCLUSIONS: NT-proBNP supported GDMT not only improves health outcomes but offers significant cost savings, demonstrating dominant economic advantage.

Code

EE81

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Trial-Based Economic Evaluation

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory)