Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study

AimsPrevention of cardiovascular disease and heart failure (HF) in a cost-effective manner is a public health goal. This work aims to assess the cost-effectiveness of the St Vincent's Screening TO Prevent Heart Failure (STOP-HF) intervention. Methods and resultsThis is a substudy of 1054 participants with cardiovascular risk factors [median age 65.8years, interquartile range (IQR) 57.8:72.4, with 4.3years, IQR 3.4:5.2, follow-up]. Annual natriuretic peptide-based screening was performed, with collaborative cardiovascular care between specialist physicians and general practitioners provided to patients with BNP levels >50pg/mL. Analysis of cost per case prevented and cost-effectiveness per quality-adjusted life year (QALY) gained was performed. The primary clinical endpoint of LV dysfunction (LVD) with or without HF was reduced in intervention patients [odds ratio (OR) 0.60; 95% confidence interval (CI) 0.38-0.94; P = 0.026]. There were 157 deaths and/or emergency hospitalizations for major adverse cardiac events (MACE) in the control group vs. 102 in the intervention group (OR 0.68; 95% CI 0.49-0.93; P = 0.01). The cost per case of LVD/HF prevented was Euro9683 (sensitivity range -Euro843 to Euro20 210), whereas the cost per MACE prevented was Euro3471 (sensitivity range -Euro302 to Euro7245). Cardiovascular hospitalization savings offset increased outpatient and primary care costs. The cost per QALY gain was Euro1104 and the intervention has an 88% probability of being cost-effective at a willingness to pay threshold of Euro30 000. ConclusionAmong patients with cardiovascular risk factors, natriuretic peptide-based screening and collaborative care reduced LVD, HF, and MACE, and has a high probability of being cost-effective. Trial registrationNCT00921960