VAP Cholesterol: This is a lipid testing panel offered by some laboratories. This panel includes: total cholesterol, total VLDL, total non-HDL, total apoB100, Lp(a), IDL LDL-RC, Total LDL-C, the LDL size pattern, HDL-2 , HDL-3, and VLDL-3. Although these are all legitimate biochemical markers that may each provide some information for a patient with a lipid disorder, they are not all clinically-indicated. The wealth of markers present in this panel does not offer significantly more information than could be gleaned from a simple HDL, LDL, triglyceride panel for the vast majority of patients. The VAP test can cost more than 50 times the cost of a simple 3-part lipid screen. The VAP test is a good candidate for being a non-formulary (totally restricted) send-out test.
CK-MB and troponin: CK-MB is a test of limited value and is considered an obsolete test by most lab directors. Some hospitals have chest panels or AMI panels that include more markers than are needed. If CK-MB is linked with troponin testing then there is a good chance the doctor is not looking at the CK-MB result, but is only getting it because it's on the panel. When hospitals unlink CK-MB and troponin, they will find that their CK-MB volume will drop significantly. Taking a marker off a panel and making it only available individually is a good way to know how valuable it is. Often we find that the orders for that individual test stop when unlinked from a panel, proving its low value to clinicians.
Allergy Testing: IgE allergy testing is useful. However, many labs have large panels that contain 20 or more allergens. Some small panels like nuts, fruits, or fish may make sense if the top 5 allergens are included. But panels with >15 allergens are excessive.
Specialty laboratories have created elaborate, overbundled panels for some diseases, such as inflammatory bowel disease, Alzheimer's disease, peripheral neuropathy, celiac disease, and other autoimmune diseases.
Unbundling some of your over-utilized tests from panels and removing overbundled send-out tests from your outside test formulary are good practices.
