LAB MANAGEMENT :: HYPONATREMIA OUTCOMES
rarely measured in a noninterventional retrospective cohort of patients with mild hyponatremia and COVID-19.35
Osmolality is a cost-effective test with a significant return on investment
Not performing osmolality testing is potentially harmful to the patient, but it is also very expensive given that some of the medications now available to treat SIADH cost $500–$1,000 per day. Just one or two misdiagnosed patients can cost the hospital system as much as the price of an osmometer, the device used to measure osmolality. This does not include the possible costs arising from litigation for malpractice due to misdiagnosis and improper treatment.55
Further, cost per
test is highly inexpensive and reimburse- ment for the test is well-established.46,56,57 The College of American Pathologists
(CAP) estimated the value generation potential of proper laboratory testing of electrolyte disorders based on Pro- metheus data and fluid and electrolyte disorders represented 1.5 percent of all potentially avoidable costs. When scaled to the national level and expanded beyond the commercial population based on the
CAP’s modeling, this represents potential avoidable costs of $1.14 billion nation- ally.6
Implementing osmolality testing
as standard of care in patients with hy- ponatremia could help optimize proper patient management to avoid unfavorable outcomes and enable hospitals to recover a significant portion of the $1.14 billion in potentially avoidable costs associated with electrolyte disorders in the United States. Figure 3 outlines the benefits of osmolality testing to stakeholders in the circle of care.
Conclusion In summary, hyponatremia represents a significant medical burden that is prevalent in various patient popula- tions. Despite published guidance on its diagnosis, clear associations with poor outcomes, increased medical costs, and significant evidence that correcting hy- ponatremia is associated with improved outcomes, the common electrolyte disor- der is often inadequately investigated or ignored. Osmolality testing is proven and medically necessary to effectively manage hyponatremia, improving outcomes and reducing excess resource utilization. However, osmolality is underutilized even though the cost per test is low, the test
is classified as ‘urgent,’ and osmometers are well-established medical devices.58 When clinicians have a clear under- standing of the importance of determin- ing the etiology of hyponatremia, and the utility of measuring osmolality to do so, it follows that they would be more likely to order the test. Osmolality testing combined with education on interpreting test results are both critical in addressing suboptimal management of hyponatremia. The return on investment would be substantial due to the low cost per test and $1.14 billion in potentially avoidable costs associated with electrolyte disorders in the United States alone. Addressing underutilization of os- molality testing in cases of hyponatremia, including education of ordering providers, is the first step in ensuring that everyone who needs an osmolality test gets one. Please visit
mlo-online.com for references.
Julie MacKenzie is Senior Manager, Clinical Product Portfolio at Advanced Instruments, LLC. She has been with Advanced Instruments for over 14 years. She received her Bachelor’s degree in Biochemistry, Cellular, and
Molecular Biology from Connecticut College and she earned her MBA from Boston College. She is passionate about improving quality of care.
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