Cost-Effectiveness of N-terminal Pro B-type Natriuretic Peptide for Evaluation and Management of People With Type 2 Diabetes in the Perspective of Brazilian Private Healthcare System

OBJECTIVES: To evaluate the cost effectiveness and the budgetary impact of a program for early diagnosis of heart failure (HF) among individuals with type 2 diabetes mellitus (T2DM) in Brazilian private healthcare system using N-terminal pro B-type natriuretic peptide (NT-proBNP) as risk indicator with cardioprotective therapy applied in those classified as high risk for HF. METHODS: A hybrid structure combining decision tree and Markov models was developed to simulate the outcomes (lifetime costs, quality-adjusted life-years, and life-years) for T2DM patients without prior HF history. Parameters were sourced from published literature and data from national surveillance reports. Brazilian utility values were used for the T2DM No-HF state, whereas utility values for chronic and advanced HF states were derived from international sources. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: NT-proBNP-based strategy was less costly and improved health outcomes, resulting in cost savings of 3172 BRL (Int$ 1321) and gains of 0.081 quality-adjusted life-years per patient. Probabilistic sensitivity analyses demonstrated a 74% probability of cost-effectiveness at the willingness-to-pay threshold (40,000 BRL; Int$ 16,666). The most influential parameter was the Hazard Ratio for HF reduction. Over a 5-year horizon, an incremental cost of 1555,683,148 BRL (Int$ 648,201,311.6) was projected because a 16% rise in cardioprotective treatment costs was not completely offset by the 2% reduction in HF management costs. CONCLUSIONS: NT-proBNP-based strategy offers improved health outcomes and cost savings by reducing the long-term HF burden. Although the short-term budget impact indicates an initial net investment, the full clinical benefit of cardioprotective treatment is observed in a longer time horizon.