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

Alannah Quinlivan, Vivek Thakkar, Wendy M R Stevens, Kathleen B Morrisroe, David Lloyd Prior, Candice Rabusa, Peter Paul Youssef, Eli Gabbay, Janet Roddy, Jennifer G Walker, Jane Zochling, Joanne M Sahhar, Peter T Nash, S Lester, Maureen Rischmueller, Susanna M Proudman, Mandana Nikpour

Research output: Contribution to journalArticleResearchpeer-review

18 Citations (Scopus)

Abstract

Background: 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 . Aim: To compare the cost of PAH screening in SSc with ASIGSTANDARD and ASIGPROPOSED algorithms. Methods: We applied both ASIGSTANDARD and ASIGPROPOSED algorithms to 643 screen-naive 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. Results: In screen-naive 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 946000 per annum with ASIGPROPOSED, with a cost saving of 851400 in each subsequent year of screening. Conclusions: ASIGPROPOSED substantially reduces the number of TTE and RHC required and results in substantial cost savings in SSc-PAH screening compared with ASIGSTANDARD. ? 2015 Royal Australasian College of Physicians.
Original languageEnglish
Pages (from-to)1134 - 1140
Number of pages7
JournalInternal Medicine Journal
Volume45
Issue number11
DOIs
Publication statusPublished - 2015

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