Heart failure & cardiomyopathiesResearch article
Cost-effectiveness of N-terminal pro-B-type natriuretic peptide thresholds for echocardiography referral in primary care heart failure management
- cost-effectiveness analysis
- decision-analytical model
- UK National Health Service perspective
- lifetime horizon
- discounted at 3.5% annually
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)
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:10.1136/heartjnl-2026-328059
Summarised from the published abstract; every number is checked against it