Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis.

Background: Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) is now standard care in this disease. The existing Australian Scleroderma Interest Group algorithm (ASIG STANDARD ) is based on transthoracic echocardiography (TTE) and pulmonary function tests (PFT). Recently, ASIG has derived and validated a new screening algorithm (ASIG PROPOSED ) that incorporates N-terminal pro-B-type natriuretic peptide level together with PFT in order to decrease reliance on TTE, which has some limitations. Right heart catheterisation (RHC) remains the gold standard for the diagnosis of PAH in patients who screen ‘positive’. Aim: To compare the cost of PAH screening in SSc with ASIGSTANDARD and ASIGPROPOSED algorithms. Methods: We applied both ASIG STANDARD and ASIG PROPOSED algorithms to 643 screen-naive SSc patients from the Australian Scleroderma Cohort Study (ASCS), assuming a PAH prevalence of 10%. We compared the costs of screening, the number of TTE required and both the total number of RHC required and the number of RHC needed to diagnose one case of PAH, and costs, according to each algorithm. We then extrapolated the costs to the estimated total Australian SSc population. Results: In screen-naive patients from the ASCS, ASIG PROPOSED resulted in 64% fewer TTE and 10% fewer RHC compared with ASIG STANDARD , with $1936 (15%) saved for each case of PAH diagnosed. When the costs were extrapolated to the entire Australian SSc population, there was an estimated screening cost saving of $946 000 per annum with ASIG PROPOSED , with a cost saving of $851 400 in each subsequent year of screening. Conclusions: ASIG PROPOSED substantially reduces the number of TTE and RHC required and results in substantial cost savings in SSc-PAH screening compared with ASIG STANDARD .