Economic Evaluation of the Implementation of High Sensitivity Troponin: An Institutional Experience

From the 2021 HVPAA National Conference

Ali Alsaad (University of Chicago/NorthShore University), Ernest Wang (NorthShore University HealthSystem), Sarah Donlan, Jeremy Smiley, Chris Boyle, Philip Krause, Mark Lampert, Gregory Mishkel, Carl Tommaso, Maureen Kharasch, Hannah Whitney, Joan Casey, Hong Lee

Background

The American College of Cardiology recommends institutional implementation of high sensitivity troponin (hs-TnT or hs-TnI) for the diagnosis of myocardial infarction (MI). Published data suggested limited role for myoglobin and CK-MB in the diagnosis and prognosis of MI since troponin is both more sensitive and specific for MI.

Objective

We aimed to study the economics of replacing 4th generation troponin T (TnT) with hs-TnT and eliminate unnecessary testing with other cardiac markers.

Methods

We implemented a protocol using hs-TnT to replace TnT in our institution. Simultaneously, we eliminated the automatic reflex testing of CK-MB with any abnormal troponin result and the cardiac markers order set that incorporated myoglobin in addition to TnT. Providers can order these markers separately if clinically indicated. Test volume was collected 3 months pre- and post-implementation of hs-TnT. We evaluated the financial saving associated with this implementation.

Results

The number of cardiac markers (CK-MB, myoglobin, TnT and hs-TnT) performed are shown in table 1. Frequency of ordering CK-MB and myoglobin decreased significantly and continued to decline over the course of the 3-month follow-up period (Figure 1). There was no significant difference in the number of hs-TnT orders as compared to TnT. Cost analysis for cardiac markers is shown in table 1. Cost associated with hs-TnT was comparably similar to TnT. Annually adjusted cost saving associated with eliminating CK-MB and myoglobin was nearly $150,000. No workflow implications were reported.

Conclusion

The use of hs-TnT appears to be cost effective and was not associated with over-testing. Eliminating unnecessary testing with other cardiac markers was associated with cost saving with no workflow implications.

Clinical Implications

Adopting new algorithm to diagnose chest pain in the emergency department along with eliminating unnecessary testing with other cardiac markers resulted in significant cost reduction. This model may provide a road map to other healthcare systems when transitioning to hs-TnT

Click here to register for the 2022 Architecture of High Value Health Care National Conference!

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPAA on Health Affairs Blog