Lp(a) testing availability, costs and interpretive thresholds vary across Australian pathology laboratories (Heart Lung Circ 2026)

Background: Levels of lipoprotein(a) [Lp(a)] are largely genetically determined and represent a causal risk factor for atherosclerotic cardiovascular disease. International recommendations suggest measuring Lp(a) at least once in a lifetime to guide risk stratification and cascade screening; however, real-world uptake remains low (<1%). This study aimed to document accessibility, costs, and methods for reporting Lp(a) levels among Australian pathology providers.

Method: A cross-sectional national review was completed in January 2025 across all public and private pathology laboratory networks from every Australian state and territory accredited by the Royal College of Pathologists of Australasia. Laboratories were contacted via structured interviews and invited to submit de-identified Lp(a) reports.

Results: Seventeen of the 18 laboratory networks contacted provided data. Six were state-wide centralised public pathology networks, and three were national private pathology networks. Lp(a) testing was available on-site at select laboratories within nine laboratory networks and available as a send-away test in the remaining eight. Out-of-pocket testing costs ranged from $0 to $75, with a median cost of $25. Among networks performing in-laboratory testing, the upper limits of the reference intervals ranged from <32 nmol/L to <72 nmol/L. Interpretive comments varied, with thresholds for increased cardiovascular risk ranging from 75 nmol/L to 125 nmol/L. A clinical recommendation for familial screening was utilised by one reporting network. Seven different guidelines were referenced among the nine networks performing Lp(a) measurements.

Conclusions: There is significant variability in the local availability, cost, and interpretive thresholds of Lp(a) testing in Australia. Harmonisation of reporting practices will be critical as interest in Lp(a) grows and targeted therapies progress through clinical development.