Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness analysis

O Wu, L Robertson, S Twaddle, G Lowe, P Clark, I Walker, I Brenkel, M Greaves, P Langhorne, L Regan, I Greer, Thrombosis Risk Economic Assesmen

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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) pound. In contrast, universal screening of women prior to prescribing combined oral contraceptives was the least cost-effective strategy (ICER 202 pound 402). 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.

Original languageEnglish
Pages (from-to)80-90
Number of pages11
JournalBritish Journal of Haematology
Volume131
DOIs
Publication statusPublished - 2005

Keywords

  • cost-effectiveness
  • thrombophilia
  • venous thromboembolism
  • prophylaxis
  • FACTOR-V-LEIDEN
  • DEEP-VEIN THROMBOSIS
  • HORMONE REPLACEMENT THERAPY
  • PROTEIN-C RESISTANCE
  • VENOUS THROMBOEMBOLISM
  • ORAL-CONTRACEPTIVES
  • MUTATION
  • MANAGEMENT
  • PREGNANCY
  • CARRIERS

Cite this

Wu, O., Robertson, L., Twaddle, S., Lowe, G., Clark, P., Walker, I., Brenkel, I., Greaves, M., Langhorne, P., Regan, L., Greer, I., & Thrombosis Risk Economic Assesmen (2005). Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness analysis. British Journal of Haematology, 131, 80-90. https://doi.org/10.1111/j.1365-2141.2005.05715.x