• JACC. Heart failure · Feb 2013

    Randomized Controlled Trial Multicenter Study Comparative Study

    Cost-effectiveness of N-terminal pro-B-type natriuretic-guided therapy in elderly heart failure patients: results from TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure).

    • Sandra Sanders-van Wijk, van AsseltAntoinette D IADDepartment of Clinical Epidemiology, Maastricht University Medical Center, Maastricht, the Netherlands., Hans Rickli, Werner Estlinbaum, Paul Erne, Peter Rickenbacher, Andre Vuillomenet, Martin Peter, Matthias E Pfisterer, Hans-Peter Brunner-La Rocca, and TIME-CHF Investigators.
    • Department of Cardiology, Maastricht University Medical Center, Cardiovascular Centre Maastricht, Maastricht, the Netherlands. Electronic address: Sandra.van.wijk@mumc.nl.
    • JACC Heart Fail. 2013 Feb 1; 1 (1): 64-71.

    ObjectivesThis study aimed to assess cost-effectiveness of N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided versus symptom-guided therapy in heart failure (HF) patients ≥60 years old.BackgroundCost-effectiveness of NT-proBNP guidance in HF patients is unclear. It may create additional costs with uncertain benefits.MethodsIn the TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure), patients with left ventricular ejection fraction (LVEF) of ≤45% were randomized to receive intensified NT-proBNP-guided therapy or standard, symptom-guided therapy. For cost-effectiveness analysis, 467 (94%) patients (age 76 ± 7 years, 66% male) were eligible. Incremental cost-effectiveness was calculated as incremental costs per gained life-year and quality-adjusted life-year (QALY) within the 18-month trial period, as defined per protocol.ResultsNT-proBNP-guided therapy was dominant (i.e., more effective and less costly) over symptom-guided therapy, saving $2,979 USD (2.5 to 97.5% confidence interval [CI]: $8,758 to $3,265) per patient, with incremental effectiveness of +0.07 life-years and +0.05 QALYs. The probability of NT-proBNP-guided therapy being dominant was 80%, and the probability of saving 1 life-year or QALY at a cost of $50,000 was 97% and 93%, respectively. Exclusion of residence costs resulted in an incremental cost-effectiveness ratio (ICER) of $5,870 per life-year gained. Cost-effectiveness of NT-proBNP-guided therapy was most pronounced in patients <75 years old and in those with <2 significant comorbidities, being dominant in all sensitivity analyses. In the worst-case scenario (excluding residence costs in those with ≥2 comorbidities), the ICER was $11,935 per life-year gained.ConclusionsNT-proBNP-guided therapy has a high probability of being cost effective in HF patients with reduced LVEF, particularly in patients age 60 to 75 years or with less than 2 comorbidities. (Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure [TIME-CHF]; ISRCTN43596477).Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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