Screening for factor V Leiden mutation before prescribing combination oral contraceptives

Objective: To evaluate the cost-effectiveness of screening for factor V Leiden mutation in women in the United States who use combination oral contraceptives. Design: Cost-effectiveness analysis. Setting: A national research reference laboratory, a university medical center, and an academic health center managed care organization. Patient(s): Women of reproductive age in the United States, Intervention(s): Baseline risk estimates of venous thromboembolic disease in the general population and in carriers of factor V Leiden mutation were calculated using available data. Main Outcome Measure(s): The number of women who would require factor V Leiden testing and the cost of identifying this cohort to prevent one death caused by venous thromboembolic disease before prescribing combination oral contraceptives. Result(s): To prevent one venous thromboembolic death attributable to the use of oral contraceptives in women with factor V Leiden mutation, >92,000 carriers would need to be identified and stopped from using these pills. The estimated charge to prevent this one death would exceed $300 million, if the price of testing were discounted to 34.5% of current charges, the cost still would be between $105 million and $130 million. Conclusion(s): Screening for factor V Leiden mutation before prescribing combination oral contraceptives is not a cost-effective use of U.S, health care dollars. The best and most cost-effective screening tool we have is taking a thorough personal and family history related to venous thromboembolic events. (Fertil Steril(R) 1999; 72:646-51. (C) 1999 by American Society for Reproductive Medicine.).