A study published in Circulation brings forward the important economic
impact of NT-proBNP
MONTREAL, June 19 /CNW Telbec/ - In Canada, heart failure (HF) affects
between 200,000 and 300,000 people (1). It is estimated that more than
106,000 patients are hospitalized for moderate to severe heart failure every
year (2) and hospital readmissions are frequent(3,4). The total annual cost of
managing HF in Canada is estimated to be between $1.4 and $2.3 billion(2,5).
The study published in Circulation
YkajnBHIzCzzUUw&keytype=ref) concludes that the use of N-terminal proB-type
natriuretic peptide (NT-proBNP), reduces total direct medical cost to the
Canadian healthcare system by 15% which may translate in annual savings
between $210 and $345 million.
Dr. Gordon W. Moe, a cardiologist and director of the heart failure
program and biomarker laboratory at St. Michael's Hospital in Toronto, Canada,
chaired this first Canadian multicenter randomized-controlled trial of the use
of NT-proBNP guided strategy in the management of suspected acute HF in the
emergency department (ED).
"Our economic analysis found that adding this test to physician judgment
reduced the duration of the emergency department visit from an average of
6.3 hours to an average of 5.6 hours," Dr. Moe said. "In addition, it reduced
the number of patients hospitalized within 60 days and reduced total direct
medical costs to the healthcare system by 15%."
The multicenter, randomized-controlled trial was conducted by the
investigators of seven Canadian hospitals: St-Michael's Hospital of Toronto
(Dr. Gordon Moe), Queen Elizabeth II Hospital in Halifax (Dr. Miroslaw Rajda),
Hôpital Laval, in Québec (Dr. Marie-Hélène Leblanc), Montreal General
Hospital, in Montreal (Dr. Thao Huynh), McMaster Health Science Corp., in
Hamilton (Dr. Andrew Worster), Foothills Medical Centre, in Calgary (Dr. Debra
Isaac) and St-Paul's Hospital, in Vancouver (Dr. Julian Marsden). Researchers
conducted the study on 500 patients, who arrived at the hospitals' emergency
with shortness of breath - a classic symptom of heart failure. Shortness of
breath is also a common symptom of other conditions such as worsening chronic
obstructive pulmonary (lung) disease, pneumonia and some heart attacks,
forcing emergency physicians to spend a lot of time trying to reach a
diagnosis. NT-proBNP facilitates differentiation of those conditions.
In this study, physicians immediately committed to a diagnosis for each
patient based on their clinical judgment. Those diagnoses were later judged by
cardiologists blinded to each patient's NT-proBNP results, which were measured
upon admission and again at 72 hours. The patients were then randomized to
receive either usual care or care guided by the NT-proBNP test results. The
median level of NT-proBNP in the 230 patients with final diagnoses of acute HF
was 3,097 picograms per milliliter (pg/ml), compared to 212 pg/ml in those
without acute decompensate HF. Knowledge of NT-proBNP results reduced the
duration of ED visit by 21% (6.3 to 5.6 hours), numbers of patients
re-hospitalized over 60 days by 35% (51 to 33) and direct medical costs of all
ED visits, hospitalizations and subsequent outpatient services by 15%
(US$6,129 to US$5,180 per patient) over 60 days from enrollment.
"In a universal-access publicly-funded healthcare system like we have in
Canada, we have to mandate judicious resource allocation. A strategy that uses
NT-proBNP in conjunction with clinical assessment improves the overall
management of patients presenting to the emergency department with suspected
acute HF through the facilitation of diagnosis, and provides health cost
savings that are accompanied by an improvement in selected clinical outcomes,"
Moe said. "The use of the NT-proBNP test will improve the overall management
of patients with suspected acute HF, and this biomarker should be part of the
routine management of these patients."
Heart Failure is associated with high morbidity and mortality. Early and
accurate diagnosis of HF is crucial for better quality of care and
cost-effective management of patients with HF. Rapid and accurate tests for
the diagnosis of HF in an urgent-care setting are therefore required.
NT-proBNP and B-type natriuretic peptide (BNP) have been shown to provide
incremental value in the rapid diagnosis of HF in the emergency room. The
N-terminal fragment of proBNP (NT-proBNP) is the high molecular weight
fragment of the precursor of BNP. Due to its greater stability, NT-proBNP may
represent a more useful diagnostic marker than BNP for cardiovascular
disorders including HF.
About Roche and the Roche Diagnostics Division
Headquartered in Basel, Switzerland, Roche is one of the world's leading
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Diagnostics Division posted sales of 8.7 billion Swiss francs. Roche employs
roughly 75,000 worldwide and has R&D agreements and strategic alliances with
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and supplies a wide array of innovative testing products and services to
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(1) Resource library: congestive heart failure statistics. Ottawa: Heart
and Stroke Foundation of Canada. Available: www.heartandstroke.ca
(2) Shibata MC, Nilsson C, Hervas-Malo M, Jacobs P, Tsuyuki RT. Economic
implications of treatment guidelines for congestive heart failure.
Can J Cardiol. 2005;21:1301-1306.
(3) Johansen H, Strauss B, Arnold JM, Moe G, Liu P. On the rise: The
current and projected future burden of congestive heart failure
hospitalization in Canada. Can J Cardiol. 2003; 19:430-435.
(4) Tsuyuki RT, Shibata MC, Nilsson C, Hervas-Malo M. Contemporary burden
of illness of congestive heart failure in Canada. Can J Cardiol.
(5) Bentkover JD, Stewart EJ, Ignaszewski A, Lepage S, Liu P, Cooper J.
New technologies and potential cost savings related to morbidity and
mortality reduction in Class III/IV heart failure in patients in
Canada. Can J Cardiol. 2003;88:33-41.
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