Canadian Study Indicates BNP Test for Suspected Heart Failure is Cost-Effective

November 16, 2006

November 16, 2006 (Chicago, IL) – The use of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) testing in conjunction with clinical assessment improves the overall management of patients presenting to the emergency room with suspected acute heart failure, and saves around $1000 per patient, according to the results of the IMPROVE-CHF study presented in a late-breaking clinical trials session here by Dr Gordon W Moe (St Michael's Hospital, Toronto, Canada).

"In the Canadian system, this test is not reimbursed by the government and its use is still limited in spite of the data," Moe told heartwire. "Canadian doctors are already very good at making a diagnosis [of heart failure] so we did the test to see if it provided incremental benefit. The test saved money because a low level is very specific at ruling out heart failure, so doctors were able to discharge patients faster. On the other hand, if you have a high level, you know the patient is going to be very sick and you can administer therapy faster."

Discussant of the trial, Dr Margaret M Redford (Rochester, MN) said the results of IMPROVE-CHF, taken together with previous studies in this area, "provide consistent and compelling proof-of-concept evidence that the use of BNP testing in the evaluation of patients with dyspnea does improve cost savings without any adverse effects on outcomes."

Reduction in duration of ER stay

Moe and colleagues randomized 501 patients presenting with shortness of breath to seven emergency departments across Canada to usual care or BNP testing. All patients actually received a BNP test, but the results were not disclosed to doctors treating the usual care group.

Physicians immediately committed to a diagnosis for each patient based on their professional opinion, and these diagnoses were later judged and confirmed by cardiologists blinded to the BNP results, which were measured in the emergency room and again at 72 hours in those who were hospitalized.

There was a significant reduction in duration of emergency room visit in the BNP group compared with the usual care patients (5.6 hours vs 6.3 hours; p=0.038), but no differences between the groups in terms of ICU admission, duration of ICU stay or initial hospitalization from the emergency department.

There were cost savings, however, of $961 per patient ($4631 per patient in the BNP group overall compared with $5592 in the usual-care group). There was also significantly reduced rehospitalization within 60 days in the BNP group (33 patients vs 51).

For a test that costs Can $21, these findings are pretty good, Moe said. In a healthcare system like that of Canada that mandates judicious use of resources, " the use of the BNP test will improve the overall management of these patients and . . . should be part of the routine management," he commented.

Findings consistent with other studies

Redford said the study had some strengths--including the fact that it excluded patients with obvious causes of dyspnea and looked at whether BNP testing adds incremental value (which few other studies have done). But it also had some limitations, she noted, such as relatively small numbers of patients, which limited the power for mortality assessment and subgroup analyses.

Also, the researchers were not really able to say whether the savings in cost were related to better and more rapid treatment of patients or due to less use of diagnostic testing, nor were they able to determine whether the assay was most helpful in ruling out, or ruling in, heart failure, she noted.

Several studies have now compared the ability of BNP to make a diagnosis of heart failure, she said, including PRIDE, BASEL, the BNP trial, and the New Zealand one. When comparing the area under the receiver operating curve (AUC) for the BNP assay with theAUC for clinical diagnosis of heart failure, the current study's findings are quite consistent with those of the other trials for both indices, she said.

In terms of cost savings, the 15% savings in cost at 60 days in IMPROVE-CHF is consistent with the other studies in which economic data were reported, such as the BASEL study, which described a 25% saving in hospital costs with the BNP test vs no test, which was maintained out to six months, she concluded.

The complete contents of Heartwire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.

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