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CC BY 4.0 · TH Open 2020; 04(03): e153-e162
DOI: 10.1055/s-0040-1714334
Original Article

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

Manila Gaddh
1   Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States
,
En Cheng
2   Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States
,
Maha A.T. Elsebaie
1   Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States
,
Imre Bodó
1   Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States
3   Department of Medicine and Hematology, Semmelweis University, Budapest, Hungary
› Author Affiliations Funding This work was supported by the Hungarian National Research Development and Innovation Office (NFKI) grant OTKA-K19_131945 (I.B.).
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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.

Keywords

venous thromboembolism - venous thrombosis - costs and cost analysis - thrombophilia - hypercoagulability

Authors' Contributions

M.G.: conceptualization, study design, data extraction and curation, manuscript drafting, and editing; E.C.: study and experimental design, data extraction, curation and analysis, and manuscript review; M.A.T.E.: experimental design, data curation and analysis, data presentation, manuscript drafting, and editing; I.B.: conceptualization, study design, and manuscript review.




Publication History

Received: 07 February 2020

Accepted: 15 June 2020

Article published online:
09 August 2020

© .

Georg Thieme Verlag KG
Stuttgart · New York

 

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