title: Reducing liver function tests for statin monitoring: an observational comparison of two clinical commissioning groups.
abstract: BACKGROUND
  Current liver function testing for statin monitoring is largely unnecessary and costly. Statins do not cause liver disease. Both reduction in test frequency and use of a single alanine transaminase (ALT) rather than a full seven analyte liver function test (LFT) array would reduce cost and may benefit patients.
  
  
  OBJECTIVE
  To assess LFT testing in relation to statin use and evaluate an intervention to reduce full-array LFTs ordered by GPs for statin monitoring.
  
  
  METHODS
  Two-year cross-sectional time series in two east London clinical commissioning groups (CCGs) with 650 000 patients. One CCG received the intervention; the other did not.
  
  
  METHODS
  The intervention comprised local guidance on LFTs for statin monitoring and access to a single ALT rather than full LFT array.
  
  
  RESULTS
  Of the total population, 17.6% were on statins, accounting for 43.2% of total LFTs. In the population without liver disease, liver function tests were 3.6 times higher for those on statins compared with those who were not. Following intervention there was a significant reduction in the full LFT array per 1000 people on statins, from 70.3 (95% confidence interval [CI] = 66.3 to 74.6) in the pre-intervention year, to 58.1 (95% CI = 55.5 to 60.7) in the post-intervention year (P<0.001). In the final month, March 2016, the rate was 53.2, a 24.3% reduction on the pre-intervention rate.
  
  
  CONCLUSIONS
  This simple and generalisable intervention, enabling ordering of a single ALT combined with information recommending prudent rather than periodic testing, reduced full LFT testing by 24.3% in people on statins. This is likely to have patient benefit at reduced cost.
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Kate
authors.initials: K
authors.lastname: Homer
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: John
authors.initials: J
authors.lastname: Robson
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Susannah
authors.initials: S
authors.lastname: Solaiman
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Abigail
authors.initials: A
authors.lastname: Davis
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Saima Zubeda
authors.initials: SZ
authors.lastname: Khan
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: David
authors.initials: D
authors.lastname: McCoy
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Rohini
authors.initials: R
authors.lastname: Mathur
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Sally
authors.initials: S
authors.lastname: Hull
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Boomla
mesh_terms: D000328:Adult; D026683:Advisory Committees; D000410:Alanine Transaminase / Q000097:blood*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D008107:Liver Diseases / Q000097:blood* / Q000503:physiopathology; D008111:Liver Function Tests / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000410:Alanine Transaminase
keywords: diagnostic tests, statins; liver function tests; primary health care; quality improvement; unnecessary procedures