B-type natriuretic peptide in the Emergency Department: the impact of restricted policies on requesting patterns and cost

Maria Salinas, Maite López-Garrigós, Emilio Flores, Miguel Ahumada, Carlos Leiva-Salinas


Background: The intent of this study was to investigate the requesting pattern of B-type natriuretic peptide (BNP) in the Emergency Department (ED) and the expenses associated with it.
Methods: Clinical laboratories of the Spanish National Health System were invited to report the number of BNP requested in the ED during 2016. The number of BNP requested per 1,000 ED admissions was calculated, and compared between laboratories. Laboratories were divided in two groups; those where BNP could be freely requested in the ED (free availability group), and those where it was regulated by algorithms/internal policies. We calculated the costs based on the provided BNP reagent prices.
Results: Sixty-five laboratories participated in the study. In 21 (32.3%) BNP was not offered in the ED. The median rate of BNP request per 1,000 ED admissions in the remaining 44 was 32.2 (IQR: 47.6). Twenty-three (52.3%) laboratories measured the BNP in the ED without any restriction. Twenty-one (17.7%) followed certain internal guidelines. The rate of request was lower in the former (21.4 vs. 47.9) (P=0.013). To measure a total of 154,702 BNP, 1,665,833€ were spent. If the demand in the free-availability group would have been the same as in the restricted-availability counterpart, 42,962 VNP requests could have been not measured, with potential savings of 462,615€.
Conclusions: One third of laboratories did not offer BNP in the ED, despite current recommendations. Institutions with policies regulating the BNP request had a lower rate of requests that those with no such regulations. If the latter would have similar policies, more than 400,000€ could have been saved in reagent costs alone.