Economic evaluation of the routine use of echocardiography versus natriuretic peptide and ECG-targeted echocardiography in the diagnosis of heart failure

Objectives: To investigate the most efficient use of echocardiography and natriuretic peptide testing in the diagnosis of heart failure.

Design: An economic model comparing two strategies: (A) provide echocardiography and electrocardiogram (ECG) for all individuals who present to a GP with symptoms that may be due to heart failure; (B) carry out B-type natriuretic peptide (BNP) blood test and ECG on all such individuals and provide echocardiography only where an abnormality is detected in one of more of these tests.

Setting: Primary care in the UK NHS.

Subjects: Individuals who present to a GP with new symptoms of heart failure.

Main outcome measures: Cost per life year gained.

Results: Baseline cost per life year gained by strategy A compared with strategy B is £3,987.

Conclusions: Immediate echocardiography is the most cost-effective option. Where echocardiography is a scarce resource, efficient use can be obtained by using BNP and ECG tests to identify patients most likely to have heart failure.