title: Assessing the clinical and cost impact of on-demand immunoassay testing for the diagnosis of heparin induced thrombocytopenia.
abstract: BACKGROUND
  The diagnostic work-up for heparin induced thrombocytopenia (HIT) can take several days. Consequently patients may be speculatively switched onto replacement anticoagulant therapy before a diagnosis is confirmed. On-demand immunoassay diagnostic testing enables timely treatment decisions, based on test results.
  
  
  OBJECTIVE
  To estimate the clinical and cost impact of the use of on-demand versus batched diagnostic tests for HIT.
  
  
  METHODS
  Literature was reviewed to identify test performance, clinical and cost data. Semi-structured interviews (n=4) and a survey (n=90) provided insights into current practice and challenges. Flow diagram models were developed to estimate the potential impact of on-demand testing.
  
  
  RESULTS
  Modelling estimated more HIT-related outcomes for patients maintained on heparin whilst awaiting test results and patients switched onto replacement anticoagulant therapy awaiting test results, compared with on-demand testing and treatment based on the results. The budget impact model estimated that on-demand testing reduced replacement anticoagulant therapy costs from $39,616 to $12,799 per patient. There are limitations to the data available to inform modelling and the estimates should be treated with caution.
  
  
  CONCLUSIONS
  Using on-demand testing may drive positive effects on clinical and cost outcomes.
authors.affiliation: Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Caton
authors.affiliation: Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom.
authors.forename: Elly
authors.initials: E
authors.lastname: O'Brien
authors.affiliation: Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom. Electronic address: anniepannelay@eiu.com.
authors.forename: Annie Jullien
authors.initials: AJ
authors.lastname: Pannelay
authors.affiliation: Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cook
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007118:Immunoassay / Q000191:economics / Q000379:methods; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis* / Q000191:economics
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Drug-related side effects and adverse reactions; Heparin; Thrombocytopenia