Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism
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 Jan...
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2020-07-01
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| Series: | TH Open |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1714334 |
| _version_ | 1818067564404670464 |
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| author | Manila Gaddh En Cheng Maha A.T. Elsebaie Imre Bodó |
| author_facet | Manila Gaddh En Cheng Maha A.T. Elsebaie Imre Bodó |
| author_sort | Manila Gaddh |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T15:25:41Z |
| format | Article |
| id | doaj.art-069e1d119630495586d5fac084232ad8 |
| institution | Directory Open Access Journal |
| issn | 2512-9465 |
| language | English |
| last_indexed | 2024-12-10T15:25:41Z |
| publishDate | 2020-07-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | TH Open |
| spelling | doaj.art-069e1d119630495586d5fac084232ad82022-12-22T01:43:33ZengGeorg Thieme Verlag KGTH Open2512-94652020-07-010403e153e16210.1055/s-0040-1714334Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous ThromboembolismManila Gaddh0En Cheng1Maha A.T. Elsebaie2Imre Bodó3Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United StatesDepartment of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United StatesDepartment of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United StatesDepartment of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United StatesIntroduction 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1714334venous thromboembolismvenous thrombosiscosts and cost analysisthrombophiliahypercoagulability |
| spellingShingle | Manila Gaddh En Cheng Maha A.T. Elsebaie Imre Bodó Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism TH Open venous thromboembolism venous thrombosis costs and cost analysis thrombophilia hypercoagulability |
| title | Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism |
| title_full | Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism |
| title_fullStr | Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism |
| title_full_unstemmed | Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism |
| title_short | Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism |
| title_sort | clinical utilization and cost of thrombophilia testing in patients with venous thromboembolism |
| topic | venous thromboembolism venous thrombosis costs and cost analysis thrombophilia hypercoagulability |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1714334 |
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