Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism.

Maha A.T Elsebaie,Manila Gaddh,En Cheng,Imre Bodó

doi:10.1055/s-0040-1714334

Abstract

Introduction Testing for inherited and acquired thrombophilias adds to the cost of care of patients with venous thromboembolism (VTE), though results may not influence patient management. Methods This is a single-center, retrospective study conducted at Emory University Hospitals from January to December 2015 to (1) determine the pattern of thrombophilia testing in patients with VTE, (2) study the impact of results of thrombophilia testing on clinical decision-making, and (3) determine the direct costs of thrombophilia testing in patients with VTE. Results Of the 266 eligible patients, 189 (71%) underwent testing; 51 (26.9%) tested positive and the results impacted management in 32 (16.9%) of tested patients. Patient undergoing testing were more likely to be younger than 40 years (30.9 vs. 18.2%), have had prior pregnancy loss (9.0 vs. 0%), or known family history of hypercoagulability (24.9 vs. 10.4%), and were less likely to have had provoked VTE (37 vs. 79.2%). The most common thrombophilias tested were antiphospholipid syndrome (60.1%), factor V Leiden (59.7%), and prothrombin gene mutation (57.5%). Direct costs of thrombophilia testing were $2,364.32 per patient, $12,331.55 to diagnose 1 positive, and $19,653.41 per patient-management affected. Conclusion We noted significant variability in selection of patients and panel of tests, sparse utilization of test results in patient management, but high cost associated with thrombophilia testing in patients with VTE. With guidelines advocating selective use of thrombophilia testing and attention to potential impact of test results in patient management, we propose the need for measures at institutional levels to improve test-ordering practices.

Highlights

Testing for inherited and acquired thrombophilias adds to the cost of care of patients with venous thromboembolism (VTE), though results may not influence patient management
We noted significant variability in selection of patients and panel of tests, sparse utilization of test results in patient management, but high cost associated with thrombophilia testing in patients with VTE
With guidelines advocating selective use of thrombophilia testing and attention to potential impact of test results in patient management, we propose the need for measures at institutional levels to improve testordering practices

Summary

Introduction

Testing for inherited and acquired thrombophilias adds to the cost of care of patients with venous thromboembolism (VTE), though results may not influence patient management. Physicians are directed to determine duration of anticoagulation for an individual patient based on an assessment of the patient’s risk for recurrent VTE and bleeding.. British and National Institute for Health and Care Excellence guidelines go on to suggest using thrombophilia testing only if it is determined that the results will impact patient management.. Determining the role of thrombophilia itself in the occurrence or recurrence of VTE in an individual patient is further complicated by the fact that multiple intrinsic and situational factors such as age, gender, body mass index, pregnancy, and postoperative state may interact variably with the underlying thrombophilia to manifest a thrombotic event. A recent systematic review and meta-analysis suggests superiority of vitamin K antagonists over direct oral anticoagulants (DOACs) in patients with high-risk antiphospholipid syndrome (APS), while reporting equivalent efficacy and safety of these treatment options in the rest of the thrombophilias.

Methods

Results

Discussion

Conclusion