Cost-Effectiveness of NT-proBNP-Guided Cardiovascular Screening in Chinese Adults With Type 2 Diabetes: Real-World Evidence From the Hong Kong Diabetes Biobank.

AIMS: Heart failure (HF) is among the most costly and prevalent complications of type 2 diabetes (T2D), with annual incremental healthcare costs reaching US$12800 in Hong Kong. We evaluated the cost-effectiveness of NT-proBNP-guided cardiovascular risk stratification to guide cardioprotective treatment.

MATERIALS AND METHODS: We developed a four-state Markov cohort model with transition probabilities estimated from the Hong Kong Diabetes Biobank (2014-2019). Patients were classified as low or high risk of HF based on NT-proBNP cut-offs of 400 and 125 pg/mL. The analysis was conducted from a payer's perspective over a lifetime horizon, utilising annual cycles and 2023 costs. Outcomes included incremental cost-effectiveness ratios (ICERs), life years (LY) and quality-adjusted life years (QALY), with a willingness-to-pay (WTP) threshold of USD 50889 to USD 152667 (1-3 × Hong Kong GDP per capita).

RESULTS: NT-proBNP screening utilising 400 pg/mL was cost-saving (ICER: -USD $6558 per QALY) versus standard of care, yielding lower costs (-USD $846) and higher QALYs (0.129). The 125 pg/mL cut-off was cost-effective (ICER: USD $29 290 per QALY). Deterministic sensitivity analysis showed NT-proBNP specificity as the key driver of ICERs in both cut-offs. Probability Sensitivity Analysis results revealed a 100% probability of dominance for the 400 pg/mL cut-off and 98% for the 125 pg/mL cut-off at Hong Kong's willingness-to-pay thresholds (USD$50,889-152,667).

CONCLUSIONS: Using NT-proBNP to prioritise use of cardioprotective treatment on top of standard of care to reduce the risk of progression to HF in Chinese patients with T2D is cost-effective, supporting its integration into clinical practise.