Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea

Background: B-type natriuretic peptide (BNP) is a quantitative marker of heart failure that seems to be helpful in its diagnosis. Methods: We 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. Results: Testing 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 vs $10503 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. Conclusion: Testing of BNP is cost-effective in patients with acute dyspnea.