Presentation (CTI)

OBJECTIVES: Heart failure (HF) presents a critical public health challenge in Vietnam, accounting for 15% of all hospital admissions. Vulnerability is highest early post-discharge, with 24.3% of patients experiencing readmission or death within 30-days due to suboptimal follow-up and under-titrated guideline-directed medical therapy (GDMT). The STRONG-HF trial demonstrated that high-intensity post-discharge care utilizing serial NT-proBNP monitoring to guide rapid GDMT up-titration significantly reduces 180-day readmissions or mortality. This approach, endorsed by the 2024 Vietnam National Heart Association guidelines, offers a transformative opportunity to optimize local HF outcomes. Accordingly, this study evaluates its economic impact, quantifying the extent to which upfront NT-proBNP testing and accelerated titration costs are offset by reductions in costly downstream clinical events.
METHODS: A 180-day cost analysis was conducted from the Vietnamese public payer perspective, comparing NT-proBNP-supported high-intensity care (HIC) with usual care (UC). The model was informed by STRONG-HF and locally adapted through consultation with Vietnamese clinicians. HIC included four follow-up visits with clinical review, laboratory testing, and serial NT-proBNP monitoring; UC included three follow-up visits guided by clinical assessment, patient tolerance, and standard biochemistry. Clinical outcomes and resource use were aligned with STRONG-HF, while costs were derived from local public databases and published literature. Uncertainty was evaluated via deterministic sensitivity and clinical scenario analyses.
RESULTS: Within 180 days post-discharge, HIC reduced all-cause mortality by 15.0% and decreased absolute HF readmission rates by 44.4% compared to UC. HIC reduced per-capita medical expenditure by 36.5% (saving 3.0 million VND/ person), as upfront outlays for lab testing and optimized GDMT were offset by avoided readmission costs. Sensitivity and scenario analyses confirmed HIC remained cost-saving across all plausible parameter variations.
CONCLUSIONS: NT-proBNP-supported intensive GDMT optimization improves health outcomes and offers substantial cost savings for Vietnam's public payer, supporting the integration of serial NT-proBNP testing into national post-discharge HF care protocols.