One-third of patients with coronary heart disease (CHD) who have met target goals for low-density lipoprotein cholesterol (LDL-C) have repeat lipid panel tests, according to a study published online July 1 in JAMA Internal Medicine. The authors say that this unnecessary testing in patients who have received no treatment intensification represents an overuse, and possibly a waste, of health care resources. The researchers analyzed medical record and prescription data from 27,947 patients with CHD treated in a primary care clinic in a Veterans Affairs (VA) network of seven medical centers. All patients had achieved LDL-C levels of less than 100 mg/dL with no intensification of lipid-lowering therapy in the 45 days after the index lipid panel. Nearly one-third of patients (32.9 percent; n=9,200) had additional lipid assessments during the 11 months of follow-up. Among the 13,114 patients who met the optional LDL-C target level of less than 70 mg/dL, repeat testing was performed in 62.4 percent. There was a mean of 1.38 additional panels performed per patient, totaling an additional 12,686 repeat panels. Based on VA cost data, the mean lipid panel cost was $16.08, for a total of $203,990 in additional annual direct costs. “This well-conceived study . . […]
One-third of patients with coronary heart disease (CHD) who have met target goals for low-density lipoprotein cholesterol (LDL-C) have repeat lipid panel tests, according to a study published online July 1 in JAMA Internal Medicine. The authors say that this unnecessary testing in patients who have received no treatment intensification represents an overuse, and possibly a waste, of health care resources.
The researchers analyzed medical record and prescription data from 27,947 patients with CHD treated in a primary care clinic in a Veterans Affairs (VA) network of seven medical centers. All patients had achieved LDL-C levels of less than 100 mg/dL with no intensification of lipid-lowering therapy in the 45 days after the index lipid panel. Nearly one-third of patients (32.9 percent; n=9,200) had additional lipid assessments during the 11 months of follow-up. Among the 13,114 patients who met the optional LDL-C target level of less than 70 mg/dL, repeat testing was performed in 62.4 percent. There was a mean of 1.38 additional panels performed per patient, totaling an additional 12,686 repeat panels. Based on VA cost data, the mean lipid panel cost was $16.08, for a total of $203,990 in additional annual direct costs.
“This well-conceived study . . . delivers an important message regarding a type of waste that is likely widespread in health care and that goes under the radar because it involves a low-cost test,” writes Joseph Drozda Jr., M.D., from the Center for Innovative Care (Chesterfield, Mo.), in an accompanying editorial. “However, it is precisely these low-cost, high-volume tests and procedures that need to be addressed if significant savings from reduction of waste are to be realized.”
Over one-third of the repeat panels (34.2 percent) were performed within six months of the index test, and 79.9 percent were performed within nine months of the index lipid panel. Results of the repeat tests were “strikingly similar” to the index lipid panel results, suggesting that major medication or therapeutic lifestyle changes were not the drivers of repeat lipid testing, the authors say. Additionally, based on the results of the repeat lipid panel, in the 45 days following the repeat test, only 6.5 percent of patients were prescribed treatment intensification. Patients with a history of diabetes mellitus and/or hypertension, an increased burden of illness, and those with more frequent primary care visits were more likely to undergo repeat testing, when adjusting for facility-level differences.
“This points toward a tendency of health care providers to order frequent laboratory testing in complex patients,” write the authors, led by Salim S. Virani, M.D., Ph.D., from Baylor College of Medicine in Houston. “Frequent lipid testing in these patients likely represents providers’ practice to order comprehensive laboratory tests (including lipid levels) rather than focusing on one clinical issue (eg, ordering glycated hemoglobin measurement to assess diabetes control).”
Takeaway: In a health care environment increasingly focused on containing costs, laboratories need to play an important role in improving the stewardship of limited health care resources. Through education efforts and electronic ordering systems, laboratories can aid clinicians in ensuring appropriate test utilization, in part by boosting efforts to reduce redundant testing.
