Heart failure & cardiomyopathies
Cost-effectiveness of N-terminal pro-B-type natriuretic peptide thresholds for echocardiography referral in primary care heart failure management
Authors' conclusion
For patients with suspected HF in primary care, the NICE diagnostic threshold represents an efficient balance between case detection and healthcare resource use. Cost-effectiveness of lower thresholds is sensitive to assumptions regarding downstream treatment patterns, highlighting the importance of real-world prescribing when evaluating diagnostic strategies.
Study context
- Population
- People with suspected heart failure (HF) in UK primary care
- Comparison
- three diagnostic strategies for suspected HF in UK primary care: echocardiography for all, the European Society of Cardiology (ESC) strategy (NT-proBNP ≥125 pg/mL) and the National Institute for Health and Care Excellence (NICE) strategy (NT-proBNP ≥400 pg/mL)
Methodological detailsdecision-analytical model, UK National Health Service perspective, lifetime horizon, discounted at 3.5% annually
- Decision-analytical model
- UK National Health Service perspective
- Lifetime horizon
- Discounted at 3.5% annually
Main finding
As reported in the abstract
Healthcare costs and QALYs (base-case) · lifetime horizon
- NICE threshold (≥400 pg/mL) associated with lower healthcare costs and similar quality-adjusted life-years (QALYs) compared with the ESC threshold (≥125 pg/mL)
Further findings
HF detection and investigations
- Lower threshold increased detection of HF but substantially increased investigations among patients without HF
Sensitivity analyses
- Results were robust across most sensitivity analyses
- Under a scenario assuming universal diuretic use among treated patients, ESC and echocardiography for all strategies generated additional QALYs at modest extra cost compared with NICE
Original publication
Cost-effectiveness of N-terminal pro-B-type natriuretic peptide thresholds for echocardiography referral in primary care heart failure management. Heart. Published 26 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it