A health economic evaluation of using N-terminal pro brain natriuretic peptide for the management of acute heart failure: A pilot study in an Indonesian tertiary referral hospital

Heart failure represents a major health problem and economic burden also in development countries such as Indonesia. Based on current guidelines, the use of natriuretic peptides can improve diagnosis, risk stratification, and decrease in hospital length of stay. However, mostly due to the related high costs, many Indonesian physicians currently do not routinely use these biomarkers in their daily clinical practice. By comparing the results of guidance with N-terminal pro brain natriuretic peptide (NT-proBNP) and without NT-proBNP, this pilot study was aimed to determine the clinical effectiveness and costs of using natriuretic peptides in the management of acute heart failure (AHF) patients admitted at National Cardiovascular Center Harapan Kita Hospital, a tertiary referral hospital in Jakarta, Indonesia. This was a health economic evaluation using a single-blind, randomized controlled trial. AHF patients adjudicated following European Society of Cardiology guidelines were randomly assigned to the 2 groups: NT-proBNP group (group A) and control group (group B). In the group A, NT-proBNP level was obtained at admission and pre-discharge, with the target of achieving a decrease of ≥30%.


Randomised patients were followed up to 90 days post-discharge to assess short-term outcomes and costs. In total, one hundred and twelve patients were enrolled, of whom 56 were randomized in group A and 56 patients in group B. Compared to Group B, in Group A the total costs of patients management resulted to be significantly higher (P<0.05), while no significant difference between the 2 groups was observed for inhospital length of stay, total mortality rate, rehospitalization, and emergency department visits within 90 days post-discharge. In this pilot study for the management of AHF at an Indonesian National Cardiovascular Center, the routine use of NT-proBNP compared to the non use, at hospital admission and discharge resulted into a significant increase of medical cost without any evident favourable impact on patients outcomes. Larger study in greater Asia Pacific populations should be performed to confirm these preliminary results.



Almazini, P., Siswanto, B. B., Meyer, M., Nadjib, M., Firdaus, I., Fuady, A., Antonini, P., & Di Somma, S. (2019). A health economic evaluation of using N-terminal pro brain natriuretic peptide for the management of acute heart failure: A pilot study in an Indonesian tertiary referral hospital. Emergency Care Journal, 15(1). https://doi.org/10.4081/ecj.2019.7919


Link di sini.

Like this article?

Share on facebook
Share on Facebook
Share on twitter
Share on Twitter
Share on linkedin
Share on Linkdin
Share on pinterest
Share on Pinterest

Leave a comment

Call for more investment in cost-effective tuberculosis care
18 Juni 2021
The global community is facing a considerable challenge to eliminate tuberculosis (TB). Although the...
Good Knowledge but Poor Practice Toward COVID-19 Among Indonesian Youth
18 Juni 2021
COVID-19 cases have been increasing among young people as they are often considered to have low compliance...
Targeted vaccine allocation could increase the covid-19 vaccine benefits amidst its lack of availability: A mathematical modeling study in indonesia
18 Juni 2021
With a limited number of vaccines and healthcare capacity shortages, particularly in low-and middle-income...
COVID-19 and tuberculosis-related catastrophic costs
28 Maret 2021
The COVID-19 pandemic has created an unprecedented health crisis and a substantial socioeconomic impact....
Cost of seeking care for tuberculosis since the implementation of universal health coverage in Indonesia
28 Maret 2021
Background Although tuberculosis (TB) patients often incur high costs to access TB-related services,...
Catastrophic costs due to tuberculosis worsen treatment outcomes: a prospective cohort study in Indonesia
28 Maret 2021
Background While the incidence of catastrophic costs due to tuberculosis (TB) remains high, there...
Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey
28 Maret 2021
Background Prognostic factors for TB-associated uveitis (TBU) remain mostly unknown, due to the challenges...
Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios
28 Maret 2021
Background The World Health Organization’s End Tuberculosis Strategy states that no tuberculosis (TB)-affected...
Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia’s implementation of universal health coverage
28 Maret 2021
Background As well as imposing an economic burden on affected households, the high costs related to...
Adaptation of the Tool to Estimate Patient Costs Questionnaire into Indonesian Context for Tuberculosis-affected Households
28 Maret 2021
BACKGROUND:Indonesia is the second-highest country for tuberculosis (TB) incidence worldwide. Hence,...