Algorithm reduces PAH screening costs in systemic sclerosis patients

By Lucy Piper, Senior medwireNews Reporter

The Australian Scleroderma Interest Group (ASIG) has derived a screening algorithm for pulmonary arterial hypertension (PAH) in patients with systemic sclerosis that saves costs by reducing the need for transthoracic echocardiography (TTE) and right heart catheterisation (RHC).

The algorithm – ASIGPROPOSED – uses the blood biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) together with pulmonary function tests to screen patients, with those screening positive subsequently referred for RHC, reducing the reliance on TTE.

Application of this screening algorithm to 643 systemic sclerosis patients from the Australian Scleroderma Cohort Study who had not previously been screened resulted in 64% fewer TTEs and 10% fewer RHCs compared with ASIGSTANDARD, which is based on TTE and pulmonary function tests.

Using ASIGPROPOSED was associated with a 50% saving, reducing the cost of screening by AUS$ 108,904.91 (€ 67,568.50) and reducing the combined cost of screening and RHC by 22%, at $ 67,753.19 (€ 42,036.50).

In subsequent years, based on an annual incidence of 2%, the yearly saving would be $ 98,065.23 (€ 60,843.20) for screening and $ 39,899.01 (€24,754.80) for screening and diagnosis combined.

The cost to diagnose one patient with PAH, assuming a baseline prevalence of 10%, would be reduced by $ 1,057.1 (€ 655,863) using ASIGPROPOSED, the researchers estimate, and by $ 3,407.57 (€ 2,114.18) in each subsequent year.

Extrapolating the findings to the Australian population of systemic sclerosis patients, estimated to number 5500, the combined saving of screening and diagnosis would be $ 580,969.4 (€ 360,454), and $ 338,349.66 (€ 209,924) per subsequent year.

In all, 256 (40%) of the study participants screened positive on ASIGSTANDARD and 132 (36%) on ASIGPROPOSED. To be considered “positive” on the ASIGPROPOSED algorithm, patients need to either have a diffusing capacity for carbon monoxide (DLCO) below 70% predicted with a ratio of forced vital capacity to DLCO of 1.8 or above, or an NT-proBNP level of 210 pg/mL or above.

This suggests that “the use of the ASIGPROPOSED algorithm reduces the cost of screening for [systemic sclerosis]-PAH, without compromising diagnostic accuracy”, comment Mandana Nikpour (The University of Melbourne, Victoria, Australia) and co-researchers in the Internal Medicine Journal.

They add: “The proposed algorithm also carries the benefit of greater convenience. NT-proBNP levels are easily measured with a simple blood test that can be performed at the time of each annual screening visit.”

The researchers hope that the cost savings and convenience of ASIGPROPOSED will result in an “improved adherence to [systemic sclerosis]-PAH screening guidelines amongst both physicians and patients, enabling earlier detection and improved outcomes.”

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