Patients who achieve low cholesterol levels still get lipid tests

One-third of patients with coronary heart disease who had low-density lipoprotein cholesterol (LDL-C) levels less than 100 mg/dL underwent repeat lipid testing anyway, a study found.

Researchers used data on patients with coronary heart disease treated at seven Veterans Affairs centers and associated community clinics. Of nearly 27,947 patients with LDL-C levels of less than 100 mg/dL, 9,200 (32.9%) had additional lipid assessments without treatment intensification during the 11 months following their initial result (12,686 total additional panels; mean, 1.38 additional panel per patient).

After adjustment for facility-level clustering, patients were more likely to undergo repeat testing if they had diabetes (odds ratio [OR], 1.16; 95% CI, 1.10 to 1.22), a history of hypertension (OR, 1.21; 95% CI, 1.13 to 1.30), greater illness burden (OR, 1.39; 95% CI, 1.23 to 1.57), or more frequent primary care visits (OR, 1.32; 95% CI, 1.25 to 1.39). Patients were less likely to undergo repeat testing if they received care at a teaching facility (OR, 0.74; 95% CI, 0.69 to 0.80), received care from a physician versus a nonphysician provider (OR, 0.93; 95% CI, 0.88 to 0.98) or had a documented high level of medication adherence (OR, 0.75; 95% CI, 0.71 to 0.80).

Researchers also found that even among the 13,114 patients who met the optimal LDL-C target level of less than 70 mg/dL, repeat lipid testing was performed in 8,177 (62.4%) during the 11 follow-up months. Results appeared online July 1 at JAMA Internal Medicine.

Many reasons exist to do extra tests, researchers noted, including a habit of ordering comprehensive laboratory tests rather than focusing on one clinical issue, or a sense of comfort to clinicians that they are being vigilant. Still, the authors continued, repeated lipid testing might be a cost-saving area to target in clinical practice, especially in light of upcoming guidelines expected to adopt a statin dose-based treatment approach in place of the current treat-to-target approach.

“With a mean lipid panel cost of $16.08 based on Veterans Health Administration laboratory cost data, this is equivalent to $203,990 in annual costs for one VA network and does not take into account the cost of the patient's time to undergo lipid testing and the cost of the provider's time to manage these results and notify the patient,” researchers wrote.

An editorial noted that the 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. 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.”