What is the most cost effective diagnostic strategy for referring people with signs and symptoms of heart failure for echocardiography?
A cost-utility anlaysis found the most cost effective diagnostic strategy for referring people with signs and symptoms of heart failure for echocardiography is to refer those with a history of myocardial infacrtion straight to echocardiography, and otherwise using an NT-proBNP threshold of 400pg/ml. This was compared to the MICE clinical decision rule (upper and lower thresholds), echo all, NT-proBNP threshold 125pg/ml and do nothing. It was cost effective compared to the do nothing strategy (ICER: 4,400 per QALY gained). This was assessed as diretly applicable with potentially serious limitations.