title: Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness analysis.
abstract: Laboratory testing for the identification of heritable thrombophilia in high-risk patient groups have become common practice; however, indiscriminate testing of all patients is unjustified. The objective of this study was to evaluate the cost-effectiveness of universal and selective history-based thrombophilia screening relative to no screening, from the perspective of the UK National Health Service, in women prior to prescribing combined oral contraceptives and hormone replacement therapy, women during pregnancy and patients prior to major orthopaedic surgery. A decision analysis model was developed, and data from meta-analysis, the literature and two Delphi studies were incorporated in the model. Incremental cost-effectiveness ratios (ICERs) for screening compared with no screening was calculated for each patient group. Of all the patient groups evaluated, universal screening of women prior to prescribing hormone replacement therapy was the most cost-effective (ICER 6824 pounds). In contrast, universal screening of women prior to prescribing combined oral contraceptives was the least cost-effective strategy (ICER 202,402 pounds). Selective thrombophilia screening based on previous personal and/or family history of venous thromboembolism was more cost-effective than universal screening in all the patient groups evaluated.
authors.affiliation: Division of Developmental Medicine, University of Glasgow, Glasgow, UK.
authors.forename: Olivia
authors.initials: O
authors.lastname: Wu
authors.forename: Lindsay
authors.initials: L
authors.lastname: Robertson
authors.forename: Sara
authors.initials: S
authors.lastname: Twaddle
authors.forename: Gordon
authors.initials: G
authors.lastname: Lowe
authors.forename: Peter
authors.initials: P
authors.lastname: Clark
authors.forename: Isobel
authors.initials: I
authors.lastname: Walker
authors.forename: Ivan
authors.initials: I
authors.lastname: Brenkel
authors.forename: Mike
authors.initials: M
authors.lastname: Greaves
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
authors.forename: Lesley
authors.initials: L
authors.lastname: Regan
authors.forename: Ian
authors.initials: I
authors.lastname: Greer
mesh_terms: D000328:Adult; D003277:Contraceptives, Oral, Combined; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003697:Delphi Technique; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D018579:Patient Selection; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D018570:Risk Assessment; D019851:Thrombophilia / Q000175:diagnosis* / Q000235:genetics; D020246:Venous Thrombosis / Q000235:genetics
chemical_list: D003277:Contraceptives, Oral, Combined