Cost-effectiveness of screening and extended anticoagulation for carriers of both factor V Leiden and prothrombin G20210A.
Carriers of a double thrombophilic mutation (factor V Leiden and prothrombin G20210A) are at high risk of a recurrent venous thromboembolism (VTE), and may benefit from a longer course of secondary prophylaxis. We examined the costs and health benefits of screening for both the mutations, provided that double heterozygotes undergo 2 years of anticoagulation as compared to the standard 6 months. We thus pooled the available evidence and calculated that the OR for recurrence in double heterozygotes was 5.9 (95% CI 2.65-13.20). A Markov model tracked patients' health lifelong, and calculated that prolonged prophylaxis saved 26 quality-adjusted days of life and $410 per double heterozygote treated. Screening all the patients with venous thromboembolism thus provided one additional day of life at the cost of 13624 $/QALY (95% CI 12 965-22 889). Screening was not cost-effective in those cohorts with a low prevalence of the mutations, a high bleeding risk or in those where prophylaxis prevented <65% of recurrences. Screening for factor V Leiden and prothrombin G20210A, with prolonged prophylaxis of double carriers, is cost-effective in most patients with VTE.
Marchetti
M
M
Laboratory of Medical Informatics, IRCCS Policlinico S.Matteo, and. Department of Computer Science and Systems, University of Pavia, Pavia, Italy. marchettim@smatteo.pv.it
Quaglini
S
S
Barosi
G
G
D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D005165:Factor V / Q000235:genetics*; D006580:Genetic Carrier Screening; D005820:Genetic Testing / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D008390:Markov Chains; D009154:Mutation / Q000235:genetics*; D016017:Odds Ratio; D011516:Prothrombin / Q000235:genetics*; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D013923:Thromboembolism / Q000188:drug therapy / Q000191:economics / Q000235:genetics*
D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin