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NT-proBNP inappropriate short-term repeat testing is associated with elevated healthcare costs
Session:
Posters - N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Speaker:
Joana Lima Lopes
Congress:
CPC 2021
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
34. Public Health and Health Economics
Subtheme:
34.3 Health Economics
Session Type:
Posters
FP Number:
---
Authors:
Joana Lima Lopes; Miguel Santos; João Bicho Augusto; Inês Fialho; Mariana Passos; João Baltazar Ferreira; Marco Beringuilho; Daniel Faria; Hilaryano Ferreira; Carlos Morais
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong>: NT-proBNP is an expensive laboratory marker used as a diagnosis and prognosis biomarker in heart failure (HF). In patients with acute decompensated HF (ADHF), it can be useful at admission and at discharge, but repeated measurement over a short period of time is inappropriate and associated with unnecessary costs. The aims of this study were to (i) determine the prevalence of inappropriate use of NT-proBNP in the hospital setting and (ii) estimate the savings associated with the implementation of a rule to avoid inappropriate testing.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong>We conducted a retrospective single-center study between January 1<sup>st</sup>and December 31<sup>st</sup>2019. Clinicians from our center have an unrestricted access to NT-proBNP testing. We collected data regarding NT-proBNP testing from the Clinical Pathology department. NT-proBNP test cost was recorded and admissions for ADHF were identified using ICD-9 coding. We chose an NT-proBNP re-testing period cut-off of <u><</u>5 days as inappropriate as this was substantially inferior to the median hospital stay for HF.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong>: 2,459 patients with a diagnosis of ADHF were evaluated at our institution during a 12-month period: 1,782 were admitted for in-hospital management and 677 patients were discharged after assessment in the emergency department. The median length-of-stay was 8.5 (5.9-16.2) days. In the same period, 11,253 NTproBNP tests were performed in both inpatient and outpatient settings, with a median value of 1,496 (353-4,931)pg/mL. The number of patients who had a repeat NT-proBNP test during 2019 was 7,331, with a median retest interval of 30 (5-89) days. Inappropriate testing occurred in 1,354 patients (55.1% of total). Considering a cost of €29.60 per test, €40,078.40 could have been saved from avoiding inappropriate NT-proBNP retesting.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong>To the best of our knowledge, this is the first Portuguese study to assess the prevalence of inappropriate NT-proBNP retesting. Inappropriate NT-proBNP retesting happened in over half of the HF patients. Implementing a mechanism to reduce or avoid inappropriate NT-proBNP retesting could have a significant impact in budget savings, particularly in high-volume hospitals.</span></span></span></p>
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