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22-03-2016 | Heart failure | Article

Cost-effectiveness of screening strategies to detect heart failure in patients with type 2 diabetes

Journal: Cardiovascular Diabetology

Authors: Anoukh van Giessen, Leandra J. M. Boonman-de Winter, Frans H. Rutten, Maarten J. Cramer, Marcel J. Landman, Anho H. Liem, Arno W. Hoes, Hendrik Koffijberg

Publisher: BioMed Central

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Abstract

Background

Heart failure (HF), especially with preserved ejection fraction (HFpEF) is common in older patients with type 2 diabetes (T2DM), but often not recognized. Early HF detection in older T2DM patients may be worthwhile because treatment may be initiated in an early stage, with clear beneficial treatment in those with reduced ejection fraction (HFrEF), but without clear prognostic beneficial treatment in those with HFpEF. Because both types of HF may be uncovered in older T2DM, screening may improve health outcomes at acceptable costs. We assessed the cost-effectiveness of five screening strategies in patients with T2DM aged 60 years or over.

Methods

We built a Markov model with a lifetime horizon based on the prognostic results from our screening study of 581 patients with T2DM, extended with evidence from literature. Cost-effectiveness was calculated from a Dutch healthcare perspective as additional costs (Euros) per additional quality-adjusted life-year (QALY) gained. We performed probabilistic sensitivity analysis to assess robustness of these outcomes. Scenario analyses were performed to assess the influence of the availability of effective treatment of heart failure with preserved ejection fraction.

Results

For willingness to pay values in the range of €6050/QALY–€31,000/QALY for men and €6300/QALY–€42,000/QALY for women, screening-based checking the electronic medical record for patient characteristics and medical history plus the assessment of symptoms had the highest probability of being cost-effective. For higher willingness-to-pay values, direct echocardiography was the preferred screening strategy. Cost-effectiveness of all screening strategies improved with the increase in effectiveness of treatment for HFpEF.

Conclusions

Screening for HF in older community-dwelling patients with T2DM is cost-effective at the commonly used willingness-to-pay threshold of €20.000/QALY by checking the electronic medical record for patient characteristics and medical history plus the assessment of symptoms. The simplicity of such a strategy makes it feasible for implementation in existing primary care diabetes management programs.
Literature
1.
Blendea MC, McFarlane SI, Isenovic ER, et al. Heart disease in diabetic patients. Curr Diab Rep. 2003;3(3):223–9.CrossRefPubMed
2.
McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;14:803–69.CrossRef
3.
van Dieren S, Beulens JW, van der Schouw YT, et al. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil. 2010;17(Suppl 1):S3–8.CrossRefPubMed
4.
Abi KC, Roussel R, Mohammedi K, et al. Cause-specific mortality in diabetes: recent changes in trend mortality. Eur J Prev Cardiol. 2012;19(3):374–81.CrossRef
5.
Boonman-de Winter LJ, Rutten FH, Cramer MJ, et al. High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia. 2012;55(8):2154–62.CrossRefPubMedPubMedCentral
6.
Paulus WJ, van Ballegoij JJ. Treatment of heart failure with normal ejection fraction: an inconvenient truth! J Am Coll Cardiol. 2010;55(6):526–37.CrossRefPubMed
7.
Boonman-de Winter LJ, Rutten FH, Cramer MJ, et al. Early recognition of heart failure in patients with diabetes type 2 in primary care. A prospective diagnostic efficiency study. (UHFO-DM2). BMC Public Health. 2009;9:479.CrossRefPubMedPubMedCentral
8.
Brooks R, Rabin R, de Charro F. The measurement and valuation of health status using EQ-5D: a European perspective. Faridabad: Kluwer Academic Publishers; 2002.
9.
Boonman-de Winter LJ, Rutten FH, Cramer MJ, et al. Efficiently screening heart failure in patients with type 2 diabetes. Eur J Heart Fail. 2014;17:187–95.CrossRefPubMed
10.
Kelder JC, Cramer MJ, van WJ, et al. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation. 2011;124(25):2865–73.CrossRefPubMed
11.
Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Making. 1993;13(4):322–38.CrossRefPubMed
12.
Hoch JS, Dewa CS. A clinician’s guide to correct cost-effectiveness analysis: think incremental not average. Can J Psychiatry. 2008;53(4):267–74.PubMed
13.
Briggs A, Claxton K, Sculpher M. Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.
14.
The Criteria Committee of the New York Heart Association. Functional capacity and objective assessment. In: Dolgin M, editor. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Little, Brown and Company, 1994. p. 253-5.
15.
Statistics Netherlands (CBS). Lifetables Dutch population by age and sex, 2006–2010. 2012.
16.
Levy WC, Mozaffarian D, Linker DT, et al. The Seattle heart failure model: prediction of survival in heart failure. Circulation. 2006;113(11):1424–33.CrossRefPubMed
17.
Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. Lancet. 2003;362(9386):777–81.CrossRefPubMed
18.
McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003;362(9386):767–71.CrossRefPubMed
19.
Palau P, Nunez E, Dominguez E, et al. Physical therapy in heart failure with preserved ejection fraction: a systematic review. Eur J Prev Cardiol. 2014;23:4–13.CrossRefPubMed
20.
Gommer AM, Poos MJJC. Heart failure: prevalence, incidence and mortality by age and sex [in Dutch]. Nationaal Kompas Volksgezondheid: Volksgezondheid Toekomst Verkenning; 2010.
21.
Kannel WB, Ho K, Thom T. Changing epidemiological features of cardiac failure. Br Heart J. 1994;72(2 Suppl):S3–9.CrossRefPubMedPubMedCentral
22.
Yao G, Freemantle N, Calvert MJ, et al. The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator. Eur Heart J. 2007;28(1):42–51.CrossRefPubMed
23.
Hoes AW, Voors AA, Rutten FH, et al. NHG-Standaard Hartfalen. Huisarts en Wetenschap. 2010;35(7):368–89.
24.
Oostenbrink JB, Bouwmans CAM, Koopmanschap MA et al. Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties inde gezondheidszorg. College voor zorgverzekeringen. Geactualiseerde versie 2004. 2004.
25.
Hakkaart-van Roijen L, Tan SS, Bouwmans CAM. Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties in degezondheidszorg. College voor zorgverzekeringen. Geactualiseerde versie 2010. 2010.
26.
Dutch Healthcare Authority (NZA). Tariffs Dutch Healthcare. 2011.
27.
College voor Zorgverzekeringen (CvZ)—The Health Care Insurance Board. Guidelines for pharmacoeconomic research. Updated version. Amstelveen: CvZ; 2006.
28.
Massie BM, Carson PE, McMurray JJ, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359(23):2456–67.CrossRefPubMed
29.
Cleland JG, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27(19):2338–45.CrossRefPubMed
30.
Chatterjee S, Moeller C, Shah N, et al. Eplerenone is not superior to older and less expensive aldosterone antagonists. Am J Med. 2012;125(8):817–25.CrossRefPubMed
31.
Liu G, Zheng XX, Xu YL, et al. Meta-analysis of the effect of statins on mortality in patients with preserved ejection fraction. Am J Cardiol. 2014;113(7):1198–204.CrossRefPubMed
32.
van Rosmalen J, de Kok IM, van Ballegooijen M. Cost-effectiveness of cervical cancer screening: cytology versus human papillomavirus DNA testing. BJOG. 2012;119(6):699–709.CrossRefPubMedPubMedCentral
33.
Senni M, Paulus WJ, Gavazzi A, et al. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes. Eur Heart J. 2014;35(40):2797–815.CrossRefPubMedPubMedCentral
34.
Gyberg V, De BD, De BG, et al. Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology. Cardiovasc Diabetol. 2015;14:133.CrossRefPubMedPubMedCentral
35.
Wang P, Huang R, Lu S, et al. HbA1c below 7% as the goal of glucose control fails to maximize the cardiovascular benefits: a meta-analysis. Cardiovasc Diabetol. 2015;14:124.CrossRefPubMedPubMedCentral
36.
Jiao F, Fung CS, Wan YF, et al. Long-term effects of the multidisciplinary risk assessment and management program for patients with diabetes mellitus (RAMP-DM): a population-based cohort study. Cardiovasc Diabetol. 2015;14:105.CrossRefPubMedPubMedCentral
37.
Ledwidge MT, O’Connell E, Gallagher J, et al. Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent’s Screening TO Prevent Heart Failure) study. Eur J Heart Fail. 2015;17(7):672–9.CrossRefPubMed
38.
National Institute for Public Health and the Environment (RIVM). Costs of diseases 2007 [in Dutch]. 2011. Report No.: 1.2.

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