Economic evaluation of NT-proBNP testing plus standard clinical assessment versus standard clinical assessment alone for the prevention of heart failure in older adults with type 2 diabetes.

Abstract

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing for early heart failure (HF) detection in asymptomatic older adults with diabetes in the USA remains limited despite guideline recommendations. This study evaluated the cost-effectiveness of incorporating NT-proBNP testing into routine clinical assessments for adults aged ≥65 years from a Medicare perspective.

Research design and methods: A five-state Markov model with an embedded decision tree compared NT-proBNP testing plus standard clinical assessments with standard assessments alone in adults aged ≥65 years with type 2 diabetes, with or without other HF risk factors. Model inputs (ie, baseline event rates, treatment effects, utilities, and costs) were derived from published literature and publicly available Medicare data. Outcomes, including direct medical costs (ie, diagnostic testing, cardioprotective treatments, HF-related hospitalization, and chronic/advanced HF treatment), life-years (LYs), and quality-adjusted life-years (QALYs), were calculated over a lifetime horizon. Sensitivity and scenario analyses were performed.

Results: Compared with standard clinical assessment alone, NT-proBNP testing prolonged survival (6.27 vs 4.99 LYs) and improved quality of life (3.45 vs 2.84 QALYs). Although lifetime HF hospitalizations were similar (0.43 vs 0.43), LY-adjusted hospitalizations were lower with NT-proBNP testing (0.29 vs 0.43). Lifetime costs were higher with NT-proBNP testing (US$117 010 vs US$92 283), reflecting longer survival and greater use of appropriate cardioprotective treatments. NT-proBNP was cost-effective, with an incremental cost per QALY gained of US$40 883. Results were robust, with the model most sensitive to changes in diabetes management costs, mortality among high-risk individuals, and cardioprotective drug effectiveness.

Conclusions: Annual NT-proBNP testing in older adults with type 2 diabetes is cost-effective for early HF detection in a Medicare setting, supporting broader adoption of guideline-recommended testing in this high-risk population.