Abstract 13263: NT-proBNP ‰Guided” Outpatient Management of Systolic Heart Failure is Cost-Saving
Background: Elevated concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP) in chronic heart failure (HF) predict events such as hospitalization. With aggressive HF care, NT-proBNP values frequently fall and correlate with improved prognosis. We recently reported that HF care “guided” by goal NT-proBNP <1000 pg/mL reduced cardiovascular adverse events compared to standard of care (SOC) management. Despite reducing events, cost-implications of NT-proBNP guided HF management remain unclear. Methods: The ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study was a prospective randomized single center open-label blinded-end point study of 151 adult patients with symptomatic chronic HF with ejection fraction <40%. Goals included SOC adjustment of HF therapies in both arms, while in the NT-proBNP arm, a supplemental goal of NT-proBNP <1000 pg/mL was sought. Inpatient, outpatient, and emergency department costs were calculated. Costs per patient were examined across the study, as well as averaged to duration of time spent in study.
Results: Total mean costs were lower in the NT-proBNP arm across the duration of the study ($35261.92 versus $42629.14; Table), driven mainly by lower inpatient costs. Adjusting costs for the time each patient spent in the study, the total mean cost per patient per day was $451.03 in the NT-proBNP arm and $580.42 in the SOC arm, with similar magnitude of reductions in both total inpatient cost and mean inpatient cost per patient per day in the NT-proBNP arm ($399.10 versus $510.43, Table). When correcting for duration in study, mean outpatient costs were also reduced in the NT-proBNP arm ($69 versus $48). Total and mean cost per day for emergency care were negligibly higher in the NT-proBNP arm.
Conclusion: In addition to reducing adverse cardiovascular events, compared to SOC management NT-proBNP guided HF care in the PROTECT study reduced health care costs by approximately 20% over 10 month follow-up.
- © 2012 by American Heart Association, Inc.