Background
Methods
The UHFO-DM2 study
Overview of the screening strategies
Model structure
Input parameters
Parameters | 0 No screening | 1 EMR symptoms | 2 EMR symptoms Physical exam | 3 EMR symptoms Physical exam NTproBNP | 4 EMR symptoms Physical exam NTproBNP ECG | 5 Echo cardio- graphy | Distribution | Source |
---|---|---|---|---|---|---|---|---|
Sensitivitya
| ||||||||
NYHA 1 | 0.000 | 0.250 | 0.250 | 0.250 | 0.500 | 1.000 | Beta | Cohort [5] |
NYHA 2 | 0.000 | 0.853 | 0.853 | 0.879 | 0.862 | 1.000 | Beta | Cohort [5] |
NYHA 3 | 0.000 | 0.923 | 0.949 | 0.897 | 0.897 | 1.000 | Beta | Cohort [5] |
NYHA 4 | 0.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | Beta | Cohort [5] |
Specificity | 1.000 | 0.610 | 0.617 | 0.652 | 0.676 | 1.000 | Beta | Cohort [5] |
Screening | ||||||||
GP | €0.00b
| €6.39 | €15.17 | €36.67 | €61.77 | €0.00c
| Gamma | |
Echocardiography | €169.38 | €169.38 | €169.38 | €169.38 | €169.38 | €169.38 | Gamma | |
ECG stress test | €94.75 | €94.75 | €94.75 | €94.75 | €94.75 | €94.75 | Gamma |
Parameters | Men | Women | Distribution | Data source | ||
---|---|---|---|---|---|---|
Detected | Undetected | Detected | Undetected | |||
Incidence | ||||||
(100,000 person-years) | 658 | 666 | Fixed | Population estimates 23;24 | ||
HF Prevalence | ||||||
NYHA I | 0.007 | 0.000 | Dirichlet | Cohort study [5] | ||
NYHA II | 0.148 | 0.142 | Dirichlet | Cohort study [5] | ||
NYHA III | 0.047 | 0.031 | Dirichlet | Cohort study [5] | ||
NYHA IV | 0.000 | 0.000 | Dirichlet | Cohort study [5] | ||
Mortality (year) | 0.010 | 0.007 | Fixed | Population estimates [20] | ||
HF Mortality (year) | ||||||
NYHA I | 0.042 | 0.043 | 0.035 | 0.036 | Fixed | Cohort estimate [5] |
NYHA II | 0.066 | 0.067 | 0.056 | 0.057 | Fixed | Cohort estimate [5] |
NYHA III | 0.103 | 0.105 | 0.087 | 0.089 | Fixed | Cohort estimate [5] |
NYHA IV | 0.159 | 0.163 | 0.137 | 0.139 | Fixed | Cohort estimate [5] |
Annual HF costsa
| ||||||
NYHA I | €1777 | €1786 | €1172 | €1100 | Gamma | Cost study [38] |
NYHA II | €2099 | €2114 | €1370 | €1302 | Gamma | Cost study [38] |
NYHA III | €3235 | €3275 | €2070 | €2018 | Gamma | Cost study [38] |
NYHA IV | €8752 | €8912 | €5470 | €5490 | Gamma | Cost study [38] |
Medication prescription | ||||||
ACE-inhibitors | 0.53 | 0.53 | 0.27 | 0.18 | Cohort study [5] | |
Beta-blockers | 0.57 | 0.50 | 0.50 | 0.50 | Cohort study [5] | |
Utilitiesb
| ||||||
Diabetes without diagnosed HF | 0.868 | Beta | Cohort study [5] | |||
NYHA I | 0.855 | 0.817 | Beta | Cohort study [5] | ||
NYHA II | 0.790 | 0.739 | Beta | Cohort study [5] | ||
NYHA III | 0.734 | 0.685 | Beta | Cohort study [5] | ||
NYHA IV | 0.665 | 0.683 | Beta | Cohort study [5] |
Health outcomes
Costs
Analyses
Scenario analyses for HFpEF medication
Results
Strategy | 0 No screening | 1 EMR symptoms | 2 EMR symptoms Physical Exam | 3 EMR symptoms Physical exam NTproBNP | 4 EMR symptoms Physical exam NTproBNP ECG | 5 Echocardiography |
---|---|---|---|---|---|---|
Life expectancy (years) | ||||||
Men | 14.726 | 14.742 | 14.742 | 14.742 | 14.742 | 14.742 |
Women | 16.830 | 16.851 | 16.851 | 16.851 | 16.851 | 16.852 |
QALY expectancy (years) | ||||||
Men | 12.345 | 12.477 | 12.477 | 12.477 | 12.477 | 12.479 |
Women | 14.047 | 14.215 | 14.215 | 14.216 | 14.215 | 14.217 |
Expected costs pp (euros) | ||||||
Men | €6795 | €7605 | €7611 | €7625 | €7642 | €7667 |
Women | €5024 | €6086 | €6093 | €6107 | €6125 | €6152 |
Strategy comparison | NA | 1 vs 0 | 2 vs 1 | 3 vs 1 | 4 vs 1 | 5 vs 1 |
Additional QALYs to comparator | ||||||
Men | NA | 0.132 | 0.000 | 0.000 | 0.000 | 0.002 |
Women | NA | 0.168 | 0.000 | 0.000 | 0.000 | 0.002 |
Additional costs to comparator | ||||||
Men | NA | €810 | NA | NA | NA | €62 |
Women | NA | €1063 | NA | NA | NA | €66 |
ICER | ||||||
Men | NA | €6115a
| Dominated | Dominated | Dominated | €29,100 |
Women | NA | €6318a
| Dominated | Dominated | Dominated | €39,326 |
Scenario analyses for HFpEF medication
Relative effectiveness | 1. EMR + symptoms vs 0. No screening | 5. Echocardiography vs 1. EMR + symptoms |
---|---|---|
Men (%) | ||
0 | €6115 | €29,100 |
10 | €5573 | €27,552 |
20 | €5067 | €26,157 |
30 | €4591 | €24,895 |
40 | €4140 | €23,749 |
50 | €3709 | €22,705 |
60 | €3293 | €21,753 |
70 | €2890 | €20,880 |
80 | €2494 | €20,079 |
90 | €2102 | €19,341 |
100 | €1711 | €18,660 |
Women (%) | ||
0 | €6318 | €39,326 |
10 | €5888 | €38,122 |
20 | €5496 | €37,015 |
30 | €5137 | €35,998 |
40 | €4807 | €35,067 |
50 | €4502 | €34,216 |
60 | €4219 | €33,442 |
70 | €3995 | €32,741 |
80 | €3706 | €32,110 |
90 | €3471 | €31,547 |
100 | €3248 | €31,049 |