Cost-effectiveness of N-terminal pro-B-type natriuretic-guided therapy in elderly heart failure patients: results from TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure)

Sandra Sanders-van Wijk, Antoinette D I van Asselt, Hans Rickli, Werner Estlinbaum, Paul Erne, Peter Rickenbacher, Andre Vuillomenet, Martin Peter, Matthias E Pfisterer, Hans-Peter Brunner-La Rocca, TIME-CHF Investigators

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    Abstract

    OBJECTIVES: This study aimed to assess cost-effectiveness of N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided versus symptom-guided therapy in heart failure (HF) patients ≥60 years old.

    BACKGROUND: Cost-effectiveness of NT-proBNP guidance in HF patients is unclear. It may create additional costs with uncertain benefits.

    METHODS: In the TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure), patients with left ventricular ejection fraction (LVEF) of ≤45% were randomized to receive intensified NT-proBNP-guided therapy or standard, symptom-guided therapy. For cost-effectiveness analysis, 467 (94%) patients (age 76 ± 7 years, 66% male) were eligible. Incremental cost-effectiveness was calculated as incremental costs per gained life-year and quality-adjusted life-year (QALY) within the 18-month trial period, as defined per protocol.

    RESULTS: NT-proBNP-guided therapy was dominant (i.e., more effective and less costly) over symptom-guided therapy, saving $2,979 USD (2.5 to 97.5% confidence interval [CI]: $8,758 to $3,265) per patient, with incremental effectiveness of +0.07 life-years and +0.05 QALYs. The probability of NT-proBNP-guided therapy being dominant was 80%, and the probability of saving 1 life-year or QALY at a cost of $50,000 was 97% and 93%, respectively. Exclusion of residence costs resulted in an incremental cost-effectiveness ratio (ICER) of $5,870 per life-year gained. Cost-effectiveness of NT-proBNP-guided therapy was most pronounced in patients <75 years old and in those with <2 significant comorbidities, being dominant in all sensitivity analyses. In the worst-case scenario (excluding residence costs in those with ≥2 comorbidities), the ICER was $11,935 per life-year gained.

    CONCLUSIONS: NT-proBNP-guided therapy has a high probability of being cost effective in HF patients with reduced LVEF, particularly in patients age 60 to 75 years or with less than 2 comorbidities. (Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure [TIME-CHF]; ISRCTN43596477).

    Original languageEnglish
    Pages (from-to)64-71
    Number of pages8
    JournalJACC. Heart failure
    Volume1
    Issue number1
    DOIs
    Publication statusPublished - Feb-2013

    Keywords

    • Cost effectiveness
    • Heart failure
    • NT-proBNP
    • ISRCTN43596477
    • amino terminal pro brain natriuretic peptide
    • adult
    • aged
    • article
    • clinical effectiveness
    • comorbidity
    • cost control
    • cost effectiveness analysis
    • drug effect
    • elderly care
    • female
    • health care cost
    • heart failure
    • heart left ventricle ejection fraction
    • human
    • intermethod comparison
    • major clinical study
    • male
    • multicenter study (topic)
    • priority journal
    • quality adjusted life year
    • randomized controlled trial (topic)
    • treatment outcome

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