Academic Journal
Cost-Effectiveness Analysis of Age-Specific N-Terminal Pro-B-Type Natriuretic Peptide Thresholds for Heart Failure Diagnosis in China: Protocol for a Markov Model-Based Study.
| Title: | Cost-Effectiveness Analysis of Age-Specific N-Terminal Pro-B-Type Natriuretic Peptide Thresholds for Heart Failure Diagnosis in China: Protocol for a Markov Model-Based Study. |
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| Authors: | Liu C; Department of Endocrinology and Metabolism and the Institute of Endocrinology, National Health Commission Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, Liaoning, China., Wang J; Department of Endocrinology and Metabolism and the Institute of Endocrinology, National Health Commission Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, Liaoning, China., Ding S; Department of Endocrinology and Metabolism and the Institute of Endocrinology, National Health Commission Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, Liaoning, China., Li Y; Department of Endocrinology and Metabolism and the Institute of Endocrinology, National Health Commission Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, Liaoning, China. |
| Source: | JMIR research protocols [JMIR Res Protoc] 2026 Jun 29; Vol. 15, pp. e95071. Date of Electronic Publication: 2026 Jun 29. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101599504 Publication Model: Electronic Cited Medium: Internet ISSN: 1929-0748 (Electronic) Linking ISSN: 19290748 NLM ISO Abbreviation: JMIR Res Protoc Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Toronto : JMIR Publications |
| MeSH Terms: | Heart Failure*/diagnosis , Heart Failure*/economics , Heart Failure*/blood , Natriuretic Peptide, Brain*/blood , Natriuretic Peptide, Brain*/analysis , Cost-Benefit Analysis*/methods , Peptide Fragments*/blood , Peptide Fragments*/analysis , Cost-Effectiveness Analysis*/methods, China/epidemiology ; Biomarkers/blood ; Humans ; Markov Chains ; Aged ; Middle Aged ; Female ; Age Factors ; Male |
| Abstract: | Background: Heart failure (HF) imposes a substantial clinical and economic burden in China. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used in the diagnostic pathway for HF, conventional thresholds are largely derived from Western populations and may not be fully applicable to Chinese adults. Objective: This study aims to evaluate the cost-effectiveness of an exploratory age-specific NT-proBNP threshold strategy compared with a conventional universal threshold strategy for HF diagnosis in China. Methods: We developed a hybrid decision-analytic model linking an initial diagnostic decision tree to long-term Markov state-transition pathways. The target population comprised adults aged ≥45 years with symptoms suggestive of HF who underwent further clinical diagnostic evaluation. The China Health and Retirement Longitudinal Study was used to inform the baseline demographic and comorbidity structure. Two diagnostic strategies were compared: (1) an exploratory age-specific NT-proBNP strategy using thresholds of 100 ng/L for individuals aged <65 years and 248 ng/L for those aged ≥65 years and (2) a conventional threshold strategy using 125 ng/L as the comparator cutoff. The analysis was conducted from the perspective of the Chinese health care system. Primary outcomes included direct medical costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. The base-case analysis used a 10-year time horizon, with annual discounting of 5% for both costs and health outcomes. Parameter uncertainty will be assessed using deterministic sensitivity analysis, probabilistic sensitivity analysis with 5000 Monte Carlo simulations, and scenario analyses. Results: This study was funded in January 2025. Model construction has been completed, and parameter collection, calibration, and validation are ongoing. The final cost-effectiveness analysis is expected to be completed after project-specific Chinese data become available. Planned outputs include total costs, quality-adjusted life-years, incremental cost-effectiveness ratios, diagnostic classification outcomes, and cost-effectiveness acceptability results. Conclusions: This protocol will assess whether age-specific NT-proBNP thresholds provide economic or clinical advantages over a conventional universal threshold strategy in the Chinese health care setting. The findings are intended to inform future diagnostic policy while explicitly acknowledging uncertainty surrounding the exploratory age-specific thresholds and other structural assumptions. International Registered Report Identifier (irrid): PRR1-10.2196/95071. (©Changyuan Liu, Jing Wang, Shuangning Ding, Yongze Li. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 29.06.2026.) |
| Contributed Indexing: | Keywords: Markov model; N-terminal pro-B-type natriuretic peptide; NT-proBNP; cost-effectiveness analysis; diagnostic strategy; heart failure; thresholds |
| Substance Nomenclature: | 114471-18-0 (Natriuretic Peptide, Brain) 0 (Peptide Fragments) 0 (pro-brain natriuretic peptide (1-76)) 0 (Biomarkers) |
| Entry Date(s): | Date Created: 20260629 Date Completed: 20260629 Latest Revision: 20260726 |
| Update Code: | 20260726 |
| PubMed Central ID: | PMC13365891 |
| DOI: | 10.2196/95071 |
| PMID: | 42372254 |
| Database: | MEDLINE |
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