The Medical Services Advisory Committee is running the ruler over an application to fund NT-proBNP testing under Medicare to help guide the treatment of patients with heart failure.

Roche Diagnostics Australia, maker of NT-proBNP tests, has asked for testing to be subsidised:

• For patients diagnosed with heart failure during a hospital admission,
• Where the intention is to treat them with at least three of four classes of GDMT: including an angiotensin-converting enzyme inhibitor (ACEi), beta blocker, mineralocorticoid receptor antagonist (MRA), and / or sodium-glucose cotransporter 2 inhibitors (SGLT2i),
• When the patient’s initial NT-pro BNP measurement was greater than 2500 pg / mL either during or immediately prior to a hospital admission.

The tests would only be available to patients treated at up to 50% of the maximum doses of guideline-directed medical therapy. They would be able to access up to five tests in a 12-month period [link here].

“While usual care primarily informs clinicians when not to escalate treatment, NT-proBNP levels provide additional guidance by indicating when it is appropriate to up-titrate or pause therapies,” Roche said in its application.

Regular testing after discharge from hospital would help clinicians decide whether to escalate treatment, which would reduce 180-day readmissions and rates of all-cause mortality, the company argued.

Roche’s proposed MBS fee was $58.50, bringing the total cost of five tests to $248.75 in any 12 month period.

“However, the actual cost is expected to be lower, depending on the number of tests provided,” it said in its application summary.

NT-proBNP is already available on the MBS, and is funded for excluding the diagnosis of heart failure in a non-hospital setting and to diagnose HF in patients with dyspnoea who present to an emergency department.

An estimated 7,150 patients would use a new Medicare item number to access the tests in the first year, Roche said.

However, the company flagged adoption testing to guide treatment would depend on changes to local care pathways. For example, access to follow-up appointments for medication dose adjustments would be necessary for the tests to have the desired impact.

“Although this may be a barrier to uptake of this technology initially, there is evidence in the Australian health system of willingness to change treatment pathways specifically for heart failure to improve patient outcomes,” Roche said.

Consultation on the proposal is open until Friday July 10.