Article Figures & Data
Figures
- Figure 1. Key structure for the decision model (the number of patients is used for illustrative purposes).
- Figure 2. Key structure of the decision model for hospital test (the number of patients is used for illustrative purposes).
- Figure 3. Cost-effectiveness scatterplot (societal cost in 2017 Euros).
Tables
Parameter Probability (base-case value) Lower and upper bounds Source Probabilities common to all strategies Prevalence of HF among patients suspected with this condition 0.5 0.45; 0.55 Expert opinion Probability of referral to pulmonary department if negative test 0.1 0.0; 0.2 Expert opinion Probability of referral to pulmonary department if positive test 0.0 0.0; 0.0 Expert opinion Probability of referral to hospital if new GP visit with false negative test result 1.0 – Expert opinion Clinical diagnosis strategy Sensitivity 0.56 0.51; 0.61 National Clinical Guideline
Centre (UK)10Specificity 0.68 0.62; 0.73 National Clinical Guideline
Centre (UK)10Probability of referral to hospital if negative test 0.6 0.4; 0.8 Expert opinion Probability of referral to hospital if positive test 1.0 – Expert opinion Probability of spirometry 0.9 0.8; 1 Expert opinion and online survey POC test strategy Sensitivity 0.9 0.85; 0.95 Schäfer et al 11
Bertsch et al 12Specificity 0.65 0.6; 0.7 Schäfer et al 11
Bertsch et al 12Probability of referral to hospital if negative test 0.4 0.3; 0.5 Expert opinion Probability of referral to hospital if positive test 1.0 – Expert opinion Probability of spirometry 0.2 0.1; 0.3 Expert opinion and online survey Hospital test strategy Sensitivity 0.9 0.85; 0.95 Schäfer et al 11
Bertsch et al 12Specificity 0.65 0.6; 0.7 Schäfer et al, 11
Bertsch et al 12Probability of referral to hospital if negative test 0.4 0.3; 0.5 Expert opinion Probability of referral to hospital if positive test 1.0 – Expert opinion Probability of phone consultation if positive test 0.2 0.1; 0.3 Estimate based on online survey Probability of spirometry 0.8 0.7; 0.9 Expert opinion and online survey HF = heart failure.
Parameter Base-case value, € Lower and upper bounds, € Calculation method or source Healthcare costs GP visit 32 22; 41 Fee schedule Spirometry 60 54; 66 Fee schedule Other test in GP surgery (ASAT, ALAT, potassium, chloride, sodium, ECG, cholesterol [total, HDL, and LDL], creatinine) 23 16; 30 Fee schedule 1-year use of diuretics, beta-blockers, and aldosterone antagonist 89 62; 115 Norwegian Pharmaceutical Product Compendium Outpatient visit 282 198; 366 Fee schedule and DRG weights Investment and maintenance of POC machine 1 1; 2 Estimation based on depreciation over 8 years, 140 tests per machine per year Test-kit POC 28 20; 36 Expected price and share of costs quality control GP telephone consultation 7 5; 9 Fee schedule Sending test to laboratory 6 4; 7 Fee schedule Laboratory test 6 4; 8 Fee schedule Patient time and travel costs Patient time costs, GP visit (2 hours) 45 32; 59 Net annual earnings Patient time costs, specialist visit (3 hours) 68 47; 88 Net annual earnings Patient travel costs, GP visit 22 16; 29 Moger et al 15 Patient travel costs, specialist visit 34 24; 44 Moger et al 15 Additional patient time costs if POC testing (20 minutes) 8 5; 10 Net annual earnings Patient time cost, telephone consultation 4 3; 5 Net 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.
Strategy Healthcare cost, € (95% CI) Patient time and travel costs, € (95% CI) Societal cost, € (95% CI) Proportion of initial incorrect diagnosis, % (95% CI) Primary care Specialist care Total Clinical diagnosis 130(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 test 161(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 test 114(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
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