Abstract

Objectives

To prevent heart failure (HF), the global longitudinal strain (GLS) emerged as a promising systolic function parameter for targeted pre-HF screening and prevention measures. This analysis investigated the cost-effectiveness of a GLS-based screening and prevention program for pre-HF in a German at-risk population.

Methods

A patient-level simulation model was developed from the perspective of the German statutory health insurance. By comparing the lifetime costs and consequences of a GLS-based screening program with those of standard of care without screening, the incremental cost-effectiveness ratio (ICER) was calculated. Input parameters were obtained from HERZCHECK trial data and the literature. Results were presented as costs per quality-adjusted life-year (QALY) and costs per life-year (LY) gained. Deterministic and probabilistic sensitivity analyses examined the robustness of the results, and a model validation was performed. An option value was calculated to reflect the impact of the potential costs and benefits of future innovations.

Results

Compared with standard of care, the GLS-based screening program resulted in both additional costs (€7031) and benefits (0.10 QALYs/0.12 LY), with an ICER of €69 543/QALY and €59 552/LY. The probabilistic sensitivity analysis showed that the GLS-based screening program was cost-effective with a probability of 67% at a willingness-to-pay threshold of €100 000/QALY. While screening only men or patients aged ≥60 years decreased the ICER by 25% and 21%, respectively, considering the option value increased the ICER by 59%.

Conclusion

Our results indicate that a GLS-based screening program could be offered at an acceptable cost-effectiveness ratio. Specifying the target population may improve the cost-effectiveness.