Table 5.
Costs of diagnosing heart failure and initiating and titrating angiotensin converting enzyme inhibitor therapy
| £ | |
|---|---|
| Diagnosis | |
| General practice opportunistic screen at annual health check | 0.00 |
| Echocardiography or referral for cardiological assessment | 70.00 |
| General practice assessment visit (to discuss test results) | 18.00 |
| Cost of diagnostic work up | 88.00 |
| Cost per case detected (assuming half of patients require angiotensin converting enzyme inhibitors) | 176.00 |
| Initiation and titration in general practice | |
| Nurse appointment (measure blood pressure and take blood) | 9.14 |
| Analysis of blood | 8.00 |
| General practitioner consultation* (view test results, start treatment or refer to cardiologist) | 18.00 |
| Start enalapril 2.5 mg twice daily (weeks 1-2) | 5.60 |
| Nurse follow up (start of week 2; measure blood pressure and take blood) | 9.14 |
| Analysis of blood | 8.00 |
| General pracitioner follow up (start of week 3; view test results, measure blood pressure, and increase dose) | 18.00 |
| Second dose of enalapril 5 mg twice daily (weeks 3-4) | 7.51 |
| Nurse follow up (start of week 4; measure blood pressure and take blood) | 9.14 |
| Analysis of blood | 8.00 |
| General practitioner follow up (start of week 5; view test results, measure blood pressure, and increase dose) | 18.00 |
| Final and long term dose of enalapril 10 mg twice daily (weeks 5-6) | 10.53 |
| Nurse follow up (start of week 6; measure blood pressure and take blood)† | 9.14 |
| Analysis of blood | 8.00 |
| Total cost of initiation and titration | 146.20 |
| Cost per patient started on angiotensin converting enzyme inhibitor‡ | 322.20 |
*
Cost per surgery consultation including practice expense, overhead and qualification elements.19
†
No subsequent general practitioner consultation is assumed if test values are normal.
‡
Cost per patient contact including qualification element.19