By Steven Reinberg
Statistics on more than 35,000 patients with coronary heart disease treated in a Houston-based Veterans Affairs network suggest this is an area of over-testing that's contributing to the nation's soaring medical costs, the study authors said.
"These results represent health care resource overuse and possibly their waste," said lead researcher Dr. Salim Virani, a cardiologist at the Michael E. DeBakey Veterans Affairs Medical Center in Houston.
The study, published online July 1 in JAMA Internal Medicine, zeroed in on almost 28,000 patients taking statin drugs that were keeping their cholesterol levels in check -- less than 100 milligrams of cholesterol per deciliter of blood.
Over 11 months, repeat tests were ordered for one-third of those patients even though their medication had not been increased, the researchers found.
In all, nearly 13,000 additional tests were performed at about $16 each, bringing the total cost for this one group of hospitals to almost $204,000.
"Apart from the costs associated with these lipid panels, this also carries with it the cost for the patient's time to undergo a repeat blood test and cost for the health care provider's time to follow up on these results after redundant testing and to inform the patient about these results," said Virani.
Most of those who underwent repeat testing had a history of diabetes, high blood pressure and more frequent doctor visits, the research team found. The extra tests likely gave some of these patients a measure of comfort, the study authors noted.
The study drew mixed reactions from other experts.
Current national guidelines recommend that patients with coronary heart disease have their cholesterol checked every four to six months, said Dr. Gregg Fonarow, professor of cardiology at the University of California, Los Angeles and a spokesman for the American Heart Association.
"This new study shows a pattern of lipid testing that is entirely consistent with current guidelines," he said. "Whether less frequent testing and monitoring would result in similar outcomes at lower cost requires more study."
Using statin therapy to achieve and maintain appropriate LDL cholesterol levels remains one of the most cost-effective therapies for preventing recurrent cardiovascular events in men and women with coronary heart disease, he said.
Dr. Joseph Drozda Jr., author of an accompanying journal editorial, said that "seemingly inexpensive tests" really add up when done in large numbers.
"These cholesterol tests were being ordered with no benefit to the patient but cost the VA more than $200,000, and this was only in seven hospitals," said Drozda, from the Center for Innovative Care at Mercy Health in Chesterfield, Mo.
Drozda thinks this is just one example of the overuse of tests. "Most physicians will tell you this is not uncommon. A lot of tests are ordered without direct benefit to the patient and result in this kind of waste," he said.
"We need to be looking for all of these sources of waste and addressing them," he added.
About one of every six adult Americans has high blood cholesterol, putting them at risk of heart disease, according to the U.S. Centers for Disease Control and Prevention.