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Cost-effectiveness of testing for hypercoagulability and effects on treatment strategies in patients with deep vein thrombosis
- Source :
-
American Journal of Medicine . Jun2004, Vol. 116 Issue 12, p816-828. 13p. - Publication Year :
- 2004
-
Abstract
- Purpose: Among patients with deep vein thrombosis, hypercoagulable conditions impart a substantial risk of recurrent thrombosis. We sought to determine the cost-effectiveness of testing for these disorders, as well as which tests should be selected and how results should be used.Methods: Using a Markov state-transition model, strategies of testing or not testing for a hypercoagulable state followed by anticoagulation for 6 to 36 months were compared in a hypothetical cohort of patients with apparently idiopathic deep vein thrombosis who were followed for life. Strategies were compared based on lifetime costs, quality-adjusted life-years (QALYs), and marginal cost-effectiveness.Results: In the base case, testing followed by 24 months of anticoagulation in patients with a hypercoagulable condition was more cost-effective ($54,820; 23.76 QALYs) than usual care, which comprised 6 months of anticoagulation without testing ($55,260; 23.72 QALYs). All hypercoagulable conditions tested were common enough and associated with a sufficient risk of recurrence to justify inclusion in a test panel. Twenty-four months of initial anticoagulation was preferred (<$50,000/QALY) for most conditions, whereas lifetime anticoagulation was preferred for patients with antiphospholipid antibody syndrome ($2928/QALY) or homozygous factor V Leiden mutation ($3804/QALY). Models using newer evidence on recurrence suggested 18 to 36 months of anticoagulation without testing as the preferred approach.CONCLUSION: Testing for hypercoagulable disorders in patients with idiopathic deep vein thrombosis followed by 2 years of anticoagulation in affected patients is cost-effective. A simpler approach of treating all patients with prolonged anticoagulation without testing is justified if data confirm the persistent risk of recurrent thrombosis. [Copyright &y& Elsevier]
- Subjects :
- *THROMBOSIS
*COST effectiveness
*ANTICOAGULANTS
*PHOSPHOLIPID antibodies
Subjects
Details
- Language :
- English
- ISSN :
- 00029343
- Volume :
- 116
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- American Journal of Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 13292043
- Full Text :
- https://doi.org/10.1016/j.amjmed.2004.01.017