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Research

Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study

Christoffer Bugge, Erik Magnus Sether, Andreas Pahle, Sigrun Halvorsen and Ivar Sonbo Kristiansen
BJGP Open 2018; 2 (3): bjgpopen18X101596. DOI: https://doi.org/10.3399/bjgpopen18X101596
Christoffer Bugge
1 PhD Candidate, Department of Health Management and Health Economics, University of Oslo, , Norway
2 Senior Economist, Oslo Economics, , Norway
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  • For correspondence: christoffer.bugge@medisin.uio.no
Erik Magnus Sether
3 Senior Partner, Oslo Economics, , Norway
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Andreas Pahle
4 GP, Boltelokka legesenter, , Norway
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Sigrun Halvorsen
5 Professor, Department of Cardiology, Oslo University Hospital, , Norway
6 Professor II, Cardiology Department, University of Oslo, , Norway
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Ivar Sonbo Kristiansen
7 Professor Emeritus, Department of Health Management and Health Economics, University of Oslo, , Norway
8 Associated Partner, Oslo Economics, , Norway
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    Figure 1. Key structure for the decision model (the number of patients is used for illustrative purposes).
  • Figure 2.
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    Figure 2. Key structure of the decision model for hospital test (the number of patients is used for illustrative purposes).
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    Figure 3. Cost-effectiveness scatterplot (societal cost in 2017 Euros).

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    Table 1. Model probabilities
    ParameterProbability (base-case value)Lower and upper boundsSource
    Probabilities common to all strategies
    Prevalence of HF among patients suspected with this condition0.50.45; 0.55Expert opinion
    Probability of referral to pulmonary department if negative test0.10.0; 0.2Expert opinion
    Probability of referral to pulmonary department if positive test0.00.0; 0.0Expert opinion
    Probability of referral to hospital if new GP visit with false negative test result1.0–Expert opinion
    Clinical diagnosis strategy
    Sensitivity0.560.51; 0.61National Clinical Guideline
    Centre (UK)10
    Specificity0.680.62; 0.73National Clinical Guideline
    Centre (UK)10
    Probability of referral to hospital if negative test0.60.4; 0.8Expert opinion
    Probability of referral to hospital if positive test1.0–Expert opinion
    Probability of spirometry0.90.8; 1Expert opinion and online survey
    POC test strategy
    Sensitivity0.90.85; 0.95Schäfer et al 11
    Bertsch et al 12
    Specificity0.650.6; 0.7Schäfer et al 11
    Bertsch et al 12
    Probability of referral to hospital if negative test0.40.3; 0.5Expert opinion
    Probability of referral to hospital if positive test1.0–Expert opinion
    Probability of spirometry0.20.1; 0.3Expert opinion and online survey
    Hospital test strategy
    Sensitivity0.9 0.85; 0.95Schäfer et al 11
    Bertsch et al 12
    Specificity0.650.6; 0.7Schäfer et al, 11
    Bertsch et al 12
    Probability of referral to hospital if negative test0.40.3; 0.5Expert opinion
    Probability of referral to hospital if positive test1.0–Expert opinion
    Probability of phone consultation if positive test0.20.1; 0.3Estimate based on online survey
    Probability of spirometry0.80.7; 0.9Expert opinion and online survey
    • HF = heart failure.

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    Table 2. Model costs (€1.00 [2017 Euro] = NOK 9.00)
    ParameterBase-case value, €Lower and upper bounds, €Calculation method or source
    Healthcare costs
    GP visit3222; 41Fee schedule
    Spirometry6054; 66Fee schedule
    Other test in GP surgery (ASAT, ALAT, potassium, chloride, sodium, ECG, cholesterol [total, HDL, and LDL], creatinine)2316; 30Fee schedule
    1-year use of diuretics, beta-blockers, and aldosterone antagonist8962; 115Norwegian Pharmaceutical Product Compendium
    Outpatient visit282198; 366Fee schedule and DRG weights
    Investment and maintenance of POC machine11; 2Estimation based on depreciation over 8 years, 140 tests per machine per year
    Test-kit POC2820; 36Expected price and share of costs quality control
    GP telephone consultation75; 9Fee schedule
    Sending test to laboratory64; 7Fee schedule
    Laboratory test64; 8Fee schedule
    Patient time and travel costs
    Patient time costs, GP visit (2 hours)4532; 59Net annual earnings
    Patient time costs, specialist visit (3 hours)6847; 88Net annual earnings
    Patient travel costs, GP visit2216; 29Moger et al 15
    Patient travel costs, specialist visit3424; 44Moger et al 15
    Additional patient time costs if POC testing (20 minutes)85; 10Net annual earnings
    Patient time cost, telephone consultation43; 5Net annual earnings
    • ALAT = alanine aminotransferase. ASAT = aspartate aminotransferase. DRG = diagnosis related groups. ECG = electrocardiography. HDL = high density lipoprotein. LDL= low density protein. NOK = Norwegian Krone. POC = point of care.

    • View popup
    Table 3. Expected 1-year costs for different strategies (€1.00 [2017 Euro] = NOK 9.00)
    StrategyHealthcare cost, € (95% CI)Patient time and travel costs, € (95% CI)Societal cost, € (95% CI)Proportion of initial incorrect diagnosis, % (95% CI)
    Primary careSpecialist careTotal
    Clinical diagnosis130(68 to 281)254
    (124 to 430)
    379(226 to 601)160
    (116 to 214)
    543
    (378 to 767)
    38.0
    (31.0 to 45.0)
    Hospital test161(133 to 194)237
    (121 to 391)
    397(276 to 554)207
    (153 to 275)
    607
    (469 to 780)
    22.0
    (16.0 to 31.0)
    POC test114(91 to 141)231
    (116 to 383)
    344(225 to 502)158
    (116 to 210)
    505
    (375 to 674)
    22.0
    (16.0 to 31.0)
    • CI = confidence interval. NOK = Norwegian Krone. POC = point of care.

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Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study
Christoffer Bugge, Erik Magnus Sether, Andreas Pahle, Sigrun Halvorsen, Ivar Sonbo Kristiansen
BJGP Open 2018; 2 (3): bjgpopen18X101596. DOI: 10.3399/bjgpopen18X101596

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Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study
Christoffer Bugge, Erik Magnus Sether, Andreas Pahle, Sigrun Halvorsen, Ivar Sonbo Kristiansen
BJGP Open 2018; 2 (3): bjgpopen18X101596. DOI: 10.3399/bjgpopen18X101596
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Keywords

  • heart failure
  • NT-proBNP
  • primary health care
  • general practice
  • point of care

More in this TOC Section

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