News & Trends - MedTech & Diagnostics
New Medicare funding for heart failure diagnosis: 17 years in the making
Diagnostics & MedTech News: Starting November 1, a new Medicare Benefits Schedule (MBS) item will apply to the use of brain natriuretic peptide (BNP) and N-terminal-pro BNP (NT-proBNP) testing for heart failure (HF), in cases where the diagnosis is suspected but uncertain.
In Australia, heart failure impacts approximately 7 out of every 1000 adults aged 45 and over. Elevated levels of BNP/NT-proBNP, a key cardiac biomarker, are often indicative of heart failure and currently subsidised for use in hospital emergency departments.
The success of Roche Diagnostics’ Medical Services Advisory Committee (MSAC) application will enable general practitioners (GPs), cardiologists, and respiratory specialists to perform BNP and NT-proBNP tests outside hospital settings before deciding on an echocardiogram referral. This achievement comes 17 years after the first MSAC application, which was initially rejected due to a “lack of cost-effectiveness” evidence.
For patients in rural and remote areas, including many Aboriginal and Torres Strait Islander people, limited access to echocardiography services due to long wait times and geographic constraints has compounded the need for timely heart failure diagnoses.
Both the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (CSANZ) include NT-proBNP quantitation in their guidelines for heart failure management. However, due to the previous lack of funding, many patients faced out-of-pocket costs, which led to lower test uptake.
“Despite the substantial limitations of the published evidence for change in management and health outcomes, MSAC considered that use of both BNP/NT-proBNP testing as a triage test for echocardiography was likely to have superior effectiveness…,” stated MSAC in its recent advice to the Health Minister.
BNP and NT-proBNP are not without their limitations, as these tests may yield false-negative results, especially in heart failure with preserved ejection fraction (HFpEF). Approximately 20-35% of HFpEF patients, who represent over half the HF patients, may show low BNP/NT-proBNP levels despite clear evidence of increased pulmonary capillary wedge pressure. This can be influenced by genetics, obesity, insulin resistance, and specific demographics, including those of African descent.
To support this shift in testing practices, MSAC has urged the Department of Health to engage with professional bodies, including the Royal Australian College of General Practitioners (RACGP), CSANZ, the Australian College of Rural and Remote Medicine (ACRRM), and the Royal College of Pathologists of Australasia (RCPA), to develop educational programs on BNP/NT-proBNP testing.
Roche Diagnostics Australia will be hosting a webinar on October 30, featuring Professor Andrew Sindone and Associate Professor Ralph Audehm, to guide GPs and cardiologists on the effective application of NT-proBNP testing in clinical practice.
Several NT-proBNP assays are commercially available, including Roche Diagnostics’ Elecsys proBNP II and proBNP II STAT assays, alongside offerings from Siemens Healthineers, BioMerieux, Abbott, Ortho, and Radiometer.
A review of the MBS-funded BNP and NT-proBNP testing in the non-hospital setting is slated for two years, ensuring that usage aligns with clinical best practices and maximises patient benefit.
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