OBJECTIVE: Clinical guidelines recommend measuring natriuretic peptides on a regular basis in individuals with type 2 diabetes (T2D) at-risk for heart failure (HF) even in the absence of HF symptoms to prevent HF progression. However, uptake of guidelines recommendation has been slow. We evaluated the economic impact of adding NT-proBNP testing to patients’ annual clinical evaluations to guide preventive treatments.
METHODS: A decision model was developed from a US, Medicare perspective. Annual clinical examination and management with NT-proBNP testing was compared with annual clinical examination and management alone, and whether NT-proBNP testing resulted in guidelines-directed management including prescription of cardioprotective treatment. NT-proBNP testing accuracy, HF disease progression, and clinical impact of cardioprotective treatments were obtained from published clinical studies. Costs were obtained from standard US costing sources and are reported in 2024 dollars. A lifetime, time horizon was taken.
RESULTS: NT-proBNP testing with annual clinical examination resulted in higher total costs ($140,204 vs. $113,273), primarily due to costs associated with increased prescriptions for guidelines-directed cardioprotective treatments ($10,191 vs. $2,017) and to increased life-years due to patients living longer (6.97 versus 5.65 years), which also yielded more quality-adjusted life-years (QALYs) (3.68 vs. 3.06). Testing with NT-proBNP resulted in more echocardiograms being incurred to confirm NT-proBNP test results and more HF hospitalizations, which were due to the extended life of patients. Annual NT-proBNP testing was cost-effective with an incremental cost-effectiveness ratio of $43,687. Sensitivity analyses confirmed the robustness of these findings, with NT-proBNP testing being cost-effective in 74.5% of probabilistic simulations at the $50,000 threshold.
CONCLUSIONS: Adding NT-proBNP testing to annual clinical examinations to facilitate prevention of chronic HF in individuals with T2D at increased risk of HF is a cost-effective strategy and provides significant health benefits in terms of life years and QALYs.
