Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness analysis.
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.
Wu
Olivia
O
Division of Developmental Medicine, University of Glasgow, Glasgow, UK.
Robertson
Lindsay
L
Twaddle
Sara
S
Lowe
Gordon
G
Clark
Peter
P
Walker
Isobel
I
Brenkel
Ivan
I
Greaves
Mike
M
Langhorne
Peter
P
Regan
Lesley
L
Greer
Ian
I
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
D003277:Contraceptives, Oral, Combined