Cost-effectiveness of screening and extended anticoagulation for carriers of both factor V Leiden and prothrombin G20210A

被引:20
作者
Marchetti, M
Quaglini, S
Barosi, G
机构
[1] Policlin San Matteo, IRCCS, Lab Med Informat, I-27100 Pavia, Italy
[2] Univ Pavia, Dept Comp Sci & Syst, I-27100 Pavia, Italy
来源
QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS | 2001年 / 94卷 / 07期
关键词
D O I
10.1093/qjmed/94.7.365
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Carriers of a double thrombophilic mutation (factor V Leiden and prothrombin G20210A) are at high risk of a recurrent venous thromboembolism (VTE), and may benefit from a longer course of secondary prophylaxis. We examined the costs and health benefits of screening for both the mutations, provided that double heterozygotes undergo 2 years of anticoagulation as compared to the standard 6 months. We thus pooled the available evidence and calculated that the OR for recurrence in double heterozygotes was 5.9 (95% CI 2.65-13.20). A Markov model tracked patients' health lifelong, and calculated that prolonged prophylaxis saved 26 quality-adjusted days of life and $410 per double heterozygote treated. Screening all the patients with venous thromboembolism thus provided one additional day of life at the cost of 13 624 $/QALY (95% Ci 12 965-22 889). Screening was not cost-effective in those cohorts with a low prevalence of the mutations, a high bleeding risk or in those where prophylaxis prevented < 65% of recurrences. Screening for factor V Leiden and prothrombin G20210A, with prolonged prophylaxis of double carriers, is cost-effective in most patients with VTE.
引用
收藏
页码:365 / 372
页数:8
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