PT  - JOURNAL ARTICLE
AU  - Bugge, Christoffer
AU  - Sether, Erik Magnus
AU  - Pahle, Andreas
AU  - Halvorsen, Sigrun
AU  - Sonbo Kristiansen, Ivar
TI  - Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study
AID  - 10.3399/bjgpopen18X101596
DP  - 2018 Oct 01
TA  - BJGP Open
PG  - bjgpopen18X101596
VI  - 2
IP  - 3
4099  - http://bjgpopen.org/content/2/3/bjgpopen18X101596.short
4100  - http://bjgpopen.org/content/2/3/bjgpopen18X101596.full
SO  - BJGP Open2018 Oct 01; 2
AB  - Background Afflicting 1–2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition.Aim The aim of this study was to estimate 1-year health outcome and costs of three diagnostic strategies: 1) history and clinical findings ('clinical diagnosis'); 2) clinical diagnosis supplemented with NTproBNP point-of-care test ('POC test') in the GP’s surgery; or (3) in hospital laboratory ('hospital test').Design & setting A decision tree model was developed to simulate 1-year patient courses with each strategy in Norway.Method Sensitivity and specificity of clinical diagnosis (56% and 68%), and of N-terminal pro B-type natriuretic peptide test ([NT-proBNP] 90% and 65%), were based on published literature. The probabilities of referral to hospital were based on a survey of Norwegian GPs (n = 103). The costs were based on various Norwegian fee schedules. Sensitivity analyses were conducted to examine the uncertainty of the results.Results The 1-year per person societal costs were €543, €505, and €607 for clinical diagnosis, POC test, and hospital test, respectively. Even though POC entails higher laboratory costs, the total primary care costs were lower because of fewer re-visits with the GP and less use of spirometry. While 38% of patients had a delayed diagnosis with clinical diagnosis, the proportions were 22% with both POC test and hospital test. Results were most sensitive to the probability of use of spirometry.Conclusion POC testing results in earlier diagnosis and lower costs than the other diagnostic modalities.