LETTER TO THE EDITOR
Year : 2015 | Volume
: 19 | Issue : 3 | Page : 436-
Comparison of direct versus Friedewald estimation of low density lipoprotein cholesterol in Indian patients: Cost-effectiveness concerns?
Lead Medical, Asia Pacific region, Ferring Pharmaceuticals Pvt. Ltd, Mumbai, Maharashtra, India
Ferring Pharmaceuticals Pvt. Ltd. 24th Floor, Sunshine Towers, Senapati Bapat Marg, Elphinstone (West), Mumbai - 400 013, Maharashtra
|How to cite this article:|
Malve H. Comparison of direct versus Friedewald estimation of low density lipoprotein cholesterol in Indian patients: Cost-effectiveness concerns?.Indian J Endocr Metab 2015;19:436-436
|How to cite this URL:|
Malve H. Comparison of direct versus Friedewald estimation of low density lipoprotein cholesterol in Indian patients: Cost-effectiveness concerns?. Indian J Endocr Metab [serial online] 2015 [cited 2021 Jan 23 ];19:436-436
Available from: https://www.ijem.in/text.asp?2015/19/3/436/152799
I have gone through an interesting original article on comparison of calculated and direct methods of estimation for low density lipoprotein-cholesterol (LDL-C) by Kannan et al.  In this study, laboratory database of 14,620 lipid profiles was analyzed to compare use of Friedewald formula (FF) and direct estimation of LDL-C and found FF is inadequate in correctly estimating the LDL-C at higher triglyceride levels (i.e. >200 mg/dl). However, FF is known to have such limitation, which is highlighted in multiple studies earlier. Recently published study of consecutive 380 lipid profiles from hyperlipidemic patients in India has shown limitations with both the direct and calculated methods for LDL-C estimation. 
The incidence of hyperlipidemia is on the rise, and this rise is correlated with change in dietary habits and lifestyle in Indian population.  The treatment options for hyperlipidemia are limited. And the treatment is often needed for long-term. The cost for the treatment including the investigations is often borne by the patients. Hence, it is necessary to justify the additional investigations.
Estimation of LDL-C by direct methods is relatively costly, involves labor, requires expensive ultracentrifuges, rotors, and tubes. It is also a time consuming and can be performed only on a few samples a day hence its use in routine clinical laboratories is limited. FF is considered cost-effective method.  It is necessary to choose the correct method for LDL-C estimation as it influences the treatment goals. However at the same time, it is imperative to find the cost-effective method. Complete assessment of the cost effectiveness requires considerations of the actual measurement costs and costs of measurement errors leading to inappropriate treatment decisions and its implications. Study by Kannan et al. has a good sample size and gives robust data on LDL-C estimation methods affecting the treatment goals. However, it will be valuable if authors also evaluate the cost-effectiveness of these methods. This will guide the clinicians to make the right choice while advising the LDL-C estimation to the patients who already bearing the economic burden of the disease.
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|2||Malve H. Comparison of direct versus Friedewald estimation of LDL cholesterol: Experience in Indian hyperlipidemic patients. Biochem Indian J 2014;8:77-81.|
|3||Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian Heart J 2008;60 2 Suppl B: B4-18.|
|4||Sahu S, Chawla R, Uppal B. Comparison of two methods of estimation of low density lipoprotein cholesterol, the direct versus friedewald estimation. Indian J Clin Biochem 2005;20:54-61.|