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Cost-effectiveness analysis of serial measurement of circulating natriuretic peptide concentration in chronic heart failure
  1. Philippe Laramée1,
  2. David Wonderling1,
  3. Sharon Swain1,
  4. Abdallah Al-Mohammad2,
  5. Jonathan Mant3
  1. 1 National Clinical Guideline Centre, Royal College of Physicians, London, UK
  2. 2 South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  3. 3 Primary Care Unit, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Philippe Laramée, National Clinical Guideline Centre, Royal College of Physicians, 11 Street Andrew's Place, Regent's Park, London NW1 4LE, UK; plaramee{at}


Objective To assess the cost-effectiveness of three monitoring strategies for optimising medical therapy in chronic heart failure (CHF).

Design This analysis was based on six randomised controlled trials. Costs were measured from a UK NHS perspective and estimated for patients’ lifetime. The health outcome was the quality-adjusted life-year (QALY).

Setting Hospital and community.

Patients Patients with CHF.

Interventions Serial measurement of natriuretic peptide (NP) by a specialist, clinical assessment by a specialist, and usual care in the community.

Main outcome measures Costs, QALYs, and incremental cost-effectiveness ratio (ICER).

Results Serial NP measurement by a specialist was the most cost-effective option in patients with CHF due to left ventricular systolic dysfunction (LVSD), showing an ICER of £3304 compared with clinical assessment. Serial NP measurement by a specialist was strongly favoured in patients with CHF from any cause, for all patients (ICER of £14 694 compared with clinical assessment by a specialist) and for the age subgroup ≤75 years (ICER of £2517 compared with usual care). However, serial NP measurement by a specialist was dominated (less effective and more costly) by alternative strategies in the subgroup age >75 years with CHF from any cause. Clinical assessment by a specialist of patients >75 years of age with CHF from any cause was cost-effective compared with usual care (ICER of £11 508).

Conclusions Serial measurement of NP concentration by a specialist is the most cost-effective strategy for CHF due to LVSD and from any cause, except in the subgroup of patients >75 years with CHF from any cause, where treatment guided by NP measurement may be harmful and not cost-effective.

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