title: Screening with the activated protein C resistance assay yields significant savings in a patient population with low prevalence of factor V leiden.
abstract: Testing for factor V Leiden can be performed with a molecular assay or a test for activated protein C resistance. We noted that physicians in our institution tended to order the molecular test 80% of the time, but the prevalence of the mutation in our patient population was less than 10%. Consequently, we decided to introduce the activated protein C resistance assay in house and consistently use it for screening before the more expensive genetic test and to negotiate a discounted charge for the latter at a reference laboratory. After 6 years since these interventions began, the prevalence of an abnormal screening test result remained low (202/2,475 [8.2%]), even among white patients (10.9%). With this simple approach, the cost to test patients for factor V Leiden decreased by more than 90%, while the productivity of our laboratory increased by the introduction of a high-volume, fully automated assay.
authors.affiliation: UAB Coagulation Service, Department of Pathology and Hospital Laboratories, University of Alabama, Birmingham, AL 35249-7331, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Taylor
authors.forename: Robert A
authors.initials: RA
authors.lastname: Oster
authors.forename: George A
authors.initials: GA
authors.lastname: Fritsma
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Tichenor
authors.forename: Cari E
authors.initials: CE
authors.lastname: Reed
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Eiland
authors.forename: Christine L
authors.initials: CL
authors.lastname: Hudson
authors.forename: Marisa B
authors.initials: MB
authors.lastname: Marques
mesh_terms: D020016:Activated Protein C Resistance / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology*; D005165:Factor V / Q000235:genetics*; D005260:Female; D005821:Genetic Techniques / Q000191:economics; D006403:Hematologic Tests / Q000191:economics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D009154:Mutation; D015995:Prevalence; D011486:Protein C / Q000032:analysis*; D012680:Sensitivity and Specificity
chemical_list: D011486:Protein C; C095381:factor V Leiden; D005165:Factor V