• Christian Mueller, Kirsten Laule-Kilian, Christian Schindler, Theresia Klima, Barbara Frana, Daniel Rodriguez, André Scholer, Michael Christ, and André P Perruchoud.
• Department of Internal Medicine, University Hospital, University of Basel, Basel, Switzerland. chmueller@uhbs.ch
• Arch Intern Med. 2006 May 22;166(10):1081-7.

BackgroundB-type natriuretic peptide (BNP) is a quantitative marker of heart failure that seems to be helpful in its diagnosis.MethodsWe performed a prospective randomized study (B-Type Natriuretic Peptide for Acute Shortness of Breath Evaluation) including 452 patients who presented to the emergency department with acute dyspnea to estimate the long-term cost-effectiveness of BNP guidance. Participants were randomly assigned to a diagnostic strategy involving the measurement of BNP levels (n = 225) or assessment in a standard manner (n = 227). Nonparametric bootstrapping was used to estimate the distribution of incremental costs and effects on the cost-effectiveness plane during 180 days of follow-up.ResultsTesting of BNP induced several important changes in management of dyspnea, including a reduction in the initial hospital admission rate, the use of intensive care, and total days in the hospital at 180 days (median, 10 days [interquartile range, 2-24 days] in the BNP group vs 14 days [interquartile range, 6-27 days] in the control group; P = .005). At 180 days, all-cause mortality was 20% in the BNP group and 23% in the control group (P = .42). Total treatment cost was significantly reduced in the BNP group (7930 dollars vs 10,503 dollars in the control group; P = .004). Analysis of incremental 180-day cost-effectiveness showed that BNP guidance resulted in lower mortality and lower cost in 80.6%, in higher mortality and lower cost in 19.3%, and in higher or lower mortality and higher cost in less than 0.1% each. Results were robust to changes in most variables but sensitive to changes in rehospitalization with BNP guidance.ConclusionTesting of BNP is cost-effective in patients with acute dyspnea.

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