Table 17:
Parameters Varied in the Sensitivity Analyses
| Parameter | Reference Case | Sensitivity Analysis |
|---|---|---|
| % of BNP and NT-proBNP | 50% BNP and 50% NT-proBNP | 100% BNP or 100% NT-proBNP |
| % living with HF needing NP testing | 56% based on IntelliHealth Ontario data83 | 30% to 80%a |
| % of incident HF cases diagnosed in ED | 50% in ED | 75% in ED or 25% in ED |
| Uptake of BNP and NT-proBNP | ED: 90% in Year 1, 100% in Years 2–5 Community care: 50% in Year 1, 75% in Year 2, 100% in Years 3–5 | Faster uptake: 100% right away in both ED and community care Slower uptake: ED: 70%, 80%, 90%, 100%, 100% in Years 1–5, respectively Community care: 25%, 50%, 75%, 100%, 100% in Years 1–5, respectively |
| % patients receiving BNP or NT-proBNP tests in the ED in the current scenario | Assume 0% since there is no programmatic funding for BNP and NT-proBNP tests in Ontario | Assume 50% to 70% of patients are currently receiving BNP or NT-proBNP tests for the diagnosis of HF in the ED (since the tests are partially funded through the hospital's global budget) |
| Additional LOS for uncorrected FN diagnoses | 2 d, based on Griffin et al54 | 0 and 4 d |
| Unit cost of BNP and NT-proBNP | ED: $75, based on current Ontario cost Community care: $28, based on BC schedule of fees |
ED: assume same as BC cost ($28) Community care: $75 for BNP and $82.5 for NT-proBNP, based on current Ontario cost |
| Sample collection fee for BNP and NT-proBNP test conducted in the community care setting | Excluded (when multiple tests are ordered for the same patient, for the same day, only one sample collection fee is allowed. For this population, they usually receive several different tests at a time, so the sample collection fee is not considered to avoid double counting) | A sample collection fee of $10.76 per test (L700)86 was included for one-third of patientsb |
| Diagnostic accuracy of standard clinical investigations alone (ED setting) | Sensitivity: 80% Specificity: 77% |
Match to BNP sensitivity: Sensitivity 95%, specificity 30% Match to BNP specificity: Sensitivity 87%, specificity 63% |
| % FN diagnoses corrected during hospital stay | 80% | 100% |
| Prevalence of HF in ED | 50% | 29% to 79%, according to Martindale et al 201628 (a systematic review) |
| Point-of-care testing | Laboratory-based test | Apply cost of point-of-care testing (assume similar accuracy as laboratory-based tests) |
Abbreviations: BNP, B-type natriuretic peptide; ED, emergency department; FN, false negative; HF, heart failure; LOS, length of stay; NP, natriuretic peptide; NT-proBNP, N-terminal proBNP.
a
Robert McKelvie, MD, email communication, January 2020; Lisa Mielniczuk, MD, email communication, January 2020.
b
Andrew Don-Wauchope, MD, email communication, December 2019.