Economic Impact of the Universal Definition of Acute Myocardial Infarction on an Inner City Teaching Hospital

Study Questions:

What is the cost-benefit of using only cardiac troponin (cTn) for the diagnosis of acute coronary syndromes?

Methods:

The universal definition of myocardial infarction (MI) recommends the measurement of cTn for the detection of myocardial necrosis. Despite this, many institutions still use creatine kinase-myocardial band (CK-MB) as part of the standard laboratory evaluation for acute MI. A survey was conducted of Kansas City hospitals and the University Health System Consortium list server for comparison of whether other institutions use one or both biomarkers. The cost savings by eliminating CK-MB on the order sets was calculated based on the annual volume of processed specimens. The cost of supplies, equipment, and materials was determined on a per test basis.

Results:

Locally, most of the responding hospitals in Kansas City and 57% of responding university hospitals surveyed stated that they use the two biomarkers for the diagnosis of acute MI. The cost savings of eliminating CK-MB on the basis of $7.05 per test results in an annualized savings of $82,894. However, because an average of only 46 tests per month were done in the last 6 months, annualized, this would result in a further reduction in cost to $3,892. The total savings would be $86,786.

Conclusions:

The authors concluded that the adoption of a single marker, cTn, for diagnosis of MI can result in a large cost savings.

Perspective:

This study shows a significant cost saving by eliminating CK-MB from standard acute MI order sets. In this era of health care reform with increased scrutiny of cost-effectiveness, the adoption of a single marker, cTn, can result in a large cost savings with no obvious detrimental effect on the quality of outcomes. However, several reports have suggested that CK-MB positivity in absence of a troponin leak is predictive. Therefore, more research is needed.

Clinical Topics: Acute Coronary Syndromes, ACS and Cardiac Biomarkers

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Biological Markers, Kansas, Cardiology, Hospitals, Teaching, Troponin


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