Blood volume analysis may help guide treatment in HF hospitalization at low cost
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Evaluation of blood volume phenotypes may not only guide treatment in HF hospitalization, but may also be cost-effective for patients, according to two posters presented at the virtual Heart Failure Society of America Scientific Meeting.
Blood volume phenotype
For this analysis, investigators assessed 245 HF admissions (mean age, 78 years; 46% with HF with reduced ejection fraction) to a single community hospital. At admission, patients underwent blood volume analysis using measurements of total blood volume and red cell volume (BVA-100, Daxor). True anemia was defined as red blood cell volume on less than 10% of ideal volume, and polycythemia was defined as more than 10% of ideal red blood cell volume.
“Treatment should be guided by the specific red cell volume phenotype and the laboratory evaluation of the anemia,” John E. Strobeck, MD, PhD, cardiologist at the Heart-Lung Center in Hawthorne, New Jersey, and colleagues wrote in one poster. “Further controlled evaluation of the impact of red cell volume phenotype on short- and long-term outcomes in hospitalized HF patients following volume-guided treatment is necessary. One evaluation summarized the prevalence, distribution and impact on length of stay of various blood volume phenotypes among patients hospitalized with HF.”
Researchers observed that 37% of participants were hypervolemic (total blood volume > 10% excess); however, 62% had true anemia.
Moreover, true anemia was equally distributed across EF ranges, being found among 50.3% of patients with HFrEF and 49.7% of those with HF with preserved EF.
According to the study, the most prevalent red blood cell volume phenotypes identified using blood volume analysis were:
- anemia with normovolemia (50%);
- anemia with hypervolemia (12%); and
- polycythemia with hypervolemia (10%).
In addition, true anemia was found in 44 of 60 patients whose length of stay was more than 10 days compared with 16 of 60 patients without anemia and a similar length of stay (P < .033).
Peripheral hematocrit measured at the time of blood volume analysis was unable to distinguish between red blood cell volume phenotypes, according to the study.
“We have not been able to break the barriers to recurrent admission and disease progression despite nearly 4 decades of advances with HF therapies,” Marc A. Silver, MD, professor of medicine at the University of Illinois College of Medicine in Chicago, told Healio. “It has become clear to me that we have overlooked the very basics, the fundamentals, of precisely measuring blood and red cell volumes. Now we know it can be done and has a highly significant impact. Anyone caring for HF patients should be using blood volume analysis to optimize the care for their patients.”
Cost-effectiveness
Another study presented at the meeting evaluated the cost-effectiveness of blood volume analysis-guided treatment to inform future HF hospitalization treatments. Investigators evaluated variables such as the blood volume analysis hospital cost multiplier; the rate that chronic HF manifested as acute HF, resulting in a new hospitalization; and the starting age of the patients and their effects on the incremental cost-effectiveness ratio (ICER).
“Daxor’s BVA-100 blood test is covered by both public and private insurance with CPT/APC coding further adding to the economic benefits for hospital systems,” Jonathan Feldschuh, AB, chief science officer at Daxor, told Healio. “It can be performed rapidly with actionable results within 60 minutes.”
For all scenarios, the ICERs were between $3,550 and $17,380.
After a probabilistic uncertainty analysis, using continuous distributions for the various model parameters, researchers found that the mean ICER was $14,200.
Investigators also performed an additional goal-seeking analysis, in which the benefit of blood volume analysis was expressed as an HR for readmission and mortality. According to the study, a 12% reduction in mortality and readmission (HR = 0.88) is enough to yield an ICER of $50,000.
“Extensive investigation of alternative scenarios makes clear that even with very conservative assumptions about costs and efficacy, blood volume analysis-guided treatment for HF is very cost-effective,” Strobeck and colleagues wrote in the poster. “ICER values for all scenarios considered were far below the threshold of $50,000, which is generally taken to represent good value for health care, including scenarios in which the hazard ratio improvement due to blood volume analysis-guided treatment is as little as 12%. The additional cost of the testing itself is small (comparable to other much less impactful diagnostic measurements that are currently undertaken).”
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Strobeck JE. Poster 132.
Strobeck JE. Poster 331. Both presented at: Heart Failure Society of America Scientific Meeting; Sept. 30-Oct. 6, 2020 (virtual meeting).
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