[Is the determination of biomarkers worth its price? Review of the literature taking brain natriuretic peptides (BNP) as an example]

Abstract

Heart failure is an important cardiac disease with an increasing prevalence in Western societies. In addition to a significant reduction of the patient's physical capability and quality of life, cardiac insufficiency is associated with considerable expenditure by national health care systems. A number of imaging techniques are available for the detection of heart failure (e.g., echocardiography), and the use of biomarkers such as brain natriuretic peptides (BNP or NT-proBNP) becomes increasingly popular in the process of screening and diagnosis. Until now, there is a lack of information regarding health-economic aspects of this biomarker use. For this reason, a systematic literature search was conducted in MEDLINE including all relevant studies published up to and including August 2009. The primary objective was to summarize the main findings of all relevant investigations which focus on health-economic aspects of BNP use as well as NT-proBNP use. Out of 64 initial search results, 13 relevant studies were identified which met the inclusion criteria. Eleven studies were finally included in this literature review. Although the methodology of these studies was very heterogeneous, the majority of investigations indicate that the use of BNP and NT-proBNP, respectively, is a cost-effective procedure for heart failure diagnosis and prognosis, as well as for heart failure screening. However, keeping in mind that the transferability of economics study results is limited due to a number of differences between national health care systems, there are no investigations with a focus on the financial implications for Germany. Further research is required in this context.