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Screening for thrombophilia in high‐risk situations: a meta‐analysis and cost‐effectiveness analysis
Author(s) -
Wu Olivia,
Robertson Lindsay,
Twaddle Sara,
Lowe Gordon,
Clark Peter,
Walker Isobel,
Brenkel Ivan,
Greaves Mike,
Langhorne Peter,
Regan Lesley,
Greer Ian
Publication year - 2005
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2005.05715.x
Subject(s) - medicine , thrombophilia , family history , cost effectiveness analysis , hormone replacement therapy (female to male) , gynecology , cost effectiveness , family medicine , pediatrics , intensive care medicine , obstetrics , surgery , thrombosis , risk analysis (engineering) , testosterone (patch)
Summary 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). In contrast, universal screening of women prior to prescribing combined oral contraceptives was the least cost‐effective strategy (ICER £202 402). 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.