Is screening for thrombophilia cost-effective? : Current Opinion in Hematology (original) (raw)

Hemostasis and thrombosis

aPublic Health and Health Policy, University of Glasgow, Glasgow, UK

bHull York Medical School, University of York, York, UK

Correspondence to Ian A. Greer, Dean, Hull York Medical School, University of York, Heslington, York YO10 5DD, UK Tel: +44 1904 321770; fax: +44 1904 321696; e-mail: [email protected]

Abstract

Purpose of review

The aim of this review was to examine the current evidence on the cost-effectiveness of screening for thrombophilia.

Recent findings

Few studies have attempted to evaluate the cost-effectiveness of screening for thrombophilia. The direct medical costs associated with screening, in order to detect one case of thrombophilia and indeed to prevent a subsequent venous thromboembolism, are high. Irrespective of patient groups, selective history-based thrombophilia screening has been shown to be more cost-effective than universal or unselected population screening. When comparing across the high-risk patient groups, screening women prior to prescribing combined oral contraceptives was the least cost-effective strategy.

Summary

Although thrombophilia is associated with a substantial increase in relative risk of venous thromboembolism, the absolute risk and the absolute numbers of expected events, and the subsequent estimated number of prevented events remain low. Based on existing evidence, screening for thrombophilia is unlikely to be cost-effective. However, the potential cost-effectiveness of thrombophilia screening may be improved if the screening strategies were to be refined through more accurate assessment of personal or family history of venous thromboembolism or the introduction of a more global coagulation test for screening.