Blog | Wednesday, July 3, 2013

QD: News Every Day--Patients who achieve low cholesterol levels still get lipid tests


One-third of patients with coronary heart disease and who had low-density cholesterol levels less than 100 mg/dL underwent repeat lipid testing anyway, a study found, marking an area where less health care testing (and spending) might be needed.

Researchers assessed more than patients with coronary heart disease and with LDL-C levels of less than 100 mg/dL and no intensification of lipid-lowering therapy who underwent repeat lipid testing during 11 months at 7 VA centers.

Results appeared online July 1 at JAMA Internal Medicine.

Of nearly 28,000 patients with LDL-C levels of less than 100 mg/dL, 9,200 (32.9%) had additional lipid assessments without treatment intensification during the study timespan (12,686 total additional panels; mean, 1.38 additional panel per patient).

After adjusting for facility-level clustering, patients were more likely to undergo repeat testing if they had diabetes (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.10-1.22), a history of hypertension (OR, 1.21; 95% CI, 1.13-1.30), more illness burden (OR, 1.39; 95% CI, 1.23-1.57), or more frequent primary care visits (OR, 1.32; 95% CI, 1.25-1.39). Patients were less likely to undergo repeat testing if they received care at a teaching facility (OR, 0.74; 95% CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95% CI, 0.88-0.98) or had a medication possession ratio of 0.8 or higher (OR, 0.75; 95% CI, 0.71-0.80).

Researchers also found that even among more than 13,000 patients who met the optional LDL-C target level of less than 70 mg/dL, repeat lipid testing was performed in nearly 8,200 (62.4% of those with LDL-C levels of less than 70 mg/dL) during the 11 follow-up months.

Researchers noted that this practice of repeated lipid testing might be an area to target in clinical practice, especially in light of an Institute of Medicine report that redefined quality care, and with the upcoming publications of guidelines that will likely adopt a medication dose-based 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. "As per the current debate in the literature, if the forthcoming Adult Treatment Panel IV cholesterol management guidelines adopt a statin dose-based approach as opposed to the current treat-to-target approach, then the need for frequent cholesterol testing in patients with CHD would be reduced even further."

An editorial noted that, "This well-conceived study on a large clinical database, which has the advantage of containing pharmacy data for use in tracking medication adherence, 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."