Screening for factor V Leiden mutation before prescribing combination oral contraceptives.
OBJECTIVE
To evaluate the cost-effectiveness of screening for factor V Leiden mutation in women in the United States who use combination oral contraceptives.


METHODS
Cost-effectiveness analysis.


METHODS
A national research reference laboratory, a university medical center, and an academic health center managed care organization.


METHODS
Women of reproductive age in the United States.


METHODS
Baseline risk estimates of venous thromboembolic disease in the general population and in carriers of factor V Leiden mutation were calculated using available data.


METHODS
The number of women who would require factor V Leiden testing and the cost of identifying this cohort to prevent one death caused by venous thromboembolic disease before prescribing combination oral contraceptives.


RESULTS
To prevent one venous thromboembolic death attributable to the use of oral contraceptives in women with factor V Leiden mutation, >92,000 carriers would need to be identified and stopped from using these pills. The estimated charge to prevent this one death would exceed $300 million. If the price of testing were discounted to 34.5% of current charges, the cost still would be between $105 million and $130 million.


CONCLUSIONS
Screening for factor V Leiden mutation before prescribing combination oral contraceptives is not a cost-effective use of U.S. health care dollars. The best and most cost-effective screening tool we have is taking a thorough personal and family history related to venous thromboembolic events.
Creinin
M D
MD
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pennsylvania 15213-3180, USA. mcreinin@mail.magee.edu
Lisman
R
R
Strickler
R C
RC
D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D011307:Drug Prescriptions; D005165:Factor V / Q000235:genetics*; D005260:Female; D006580:Genetic Carrier Screening / Q000379:methods; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D009154:Mutation; D013923:Thromboembolism / Q000139:chemically induced / Q000401:mortality / Q000517:prevention & control
D003277:Contraceptives, Oral, Combined; C095381:factor V Leiden; D005165:Factor V