Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis

Quinlivan, A., Thakkar, V., Stevens, W., Morrisroe, K.., Prior, D., Rabusa, C., Youssef, P., Gabbay, E., Roddy, J., Walker, J. G., Zochling, J., Sahhar, J., Nash, P., Lester, S., Rischmueller, M., Proudman, S. M. and Nikpour, M. (2015) Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis. Internal medicine journal, 45 11: 1134-40. doi:10.1111/imj.12890

Author Quinlivan, A.
Thakkar, V.
Stevens, W.
Morrisroe, K..
Prior, D.
Rabusa, C.
Youssef, P.
Gabbay, E.
Roddy, J.
Walker, J. G.
Zochling, J.
Sahhar, J.
Nash, P.
Lester, S.
Rischmueller, M.
Proudman, S. M.
Nikpour, M.
Title Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis
Journal name Internal medicine journal   Check publisher's open access policy
ISSN 1445-5994
Publication date 2015-11-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/imj.12890
Open Access Status Not yet assessed
Volume 45
Issue 11
Start page 1134
End page 40
Total pages 7
Place of publication Richmond, VIC., Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Abstract Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) is now standard care in this disease. The existing Australian Scleroderma Interest Group algorithm (ASIGSTANDARD ) is based on transthoracic echocardiography (TTE) and pulmonary function tests (PFT). Recently, ASIG has derived and validated a new screening algorithm (ASIGPROPOSED ) that incorporates N-terminal pro-B-type natriuretic peptide level together with PFT in order to decrease reliance on TTE, which has some limitations. Right heart catheterisation (RHC) remains the gold standard for the diagnosis of PAH in patients who screen 'positive'.

To compare the cost of PAH screening in SSc with ASIGSTANDARD and ASIGPROPOSED algorithms.

We applied both ASIGSTANDARD and ASIGPROPOSED algorithms to 643 screen-naïve SSc patients from the Australian Scleroderma Cohort Study (ASCS), assuming a PAH prevalence of 10%. We compared the costs of screening, the number of TTE required and both the total number of RHC required and the number of RHC needed to diagnose one case of PAH, and costs, according to each algorithm. We then extrapolated the costs to the estimated total Australian SSc population.

In screen-naïve patients from the ASCS, ASIGPROPOSED resulted in 64% fewer TTE and 10% fewer RHC compared with ASIGSTANDARD , with $1936 (15%) saved for each case of PAH diagnosed. When the costs were extrapolated to the entire Australian SSc population, there was an estimated screening cost saving of $946 000 per annum with ASIGPROPOSED , with a cost saving of $851 400 in each subsequent year of screening.

ASIGPROPOSED substantially reduces the number of TTE and RHC required and results in substantial cost savings in SSc-PAH screening compared with ASIGSTANDARD .
Keyword Algorithm
Pulmonary arterial hypertension
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: UQ Centre for Clinical Research Publications
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