Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom.
Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom.
Thromb Res. 2016 Apr;140:155-162. doi: 10.1016/j.thromres.2016.01.025. Epub 2016 Feb 23.
The diagnostic work-up for heparin induced thrombocytopenia (HIT) can take several days. Consequently patients may be speculatively switched onto replacement anticoagulant therapy before a diagnosis is confirmed. On-demand immunoassay diagnostic testing enables timely treatment decisions, based on test results.
To estimate the clinical and cost impact of the use of on-demand versus batched diagnostic tests for HIT.
Literature was reviewed to identify test performance, clinical and cost data. Semi-structured interviews (n=4) and a survey (n=90) provided insights into current practice and challenges. Flow diagram models were developed to estimate the potential impact of on-demand testing.
Modelling estimated more HIT-related outcomes for patients maintained on heparin whilst awaiting test results and patients switched onto replacement anticoagulant therapy awaiting test results, compared with on-demand testing and treatment based on the results. The budget impact model estimated that on-demand testing reduced replacement anticoagulant therapy costs from $39,616 to $12,799 per patient. There are limitations to the data available to inform modelling and the estimates should be treated with caution.
Using on-demand testing may drive positive effects on clinical and cost outcomes.
肝素诱导的血小板减少症（HIT）的诊断过程可能需要数天时间。因此，在确诊之前，患者可能会被推测性地转换为替代抗凝治疗。按需免疫检测诊断测试可以根据测试结果及时做出治疗决策。
评估按需与分批检测 HIT 的临床和成本影响。
回顾文献以确定检测性能、临床和成本数据。半结构化访谈（n=4）和调查（n=90）提供了对当前实践和挑战的深入了解。流程图模型用于估计按需检测的潜在影响。
与按需检测和基于检测结果的治疗相比，模型估计在等待检测结果期间维持肝素治疗的患者和等待检测结果期间转换为替代抗凝治疗的患者有更多的 HIT 相关结果。预算影响模型估计，按需检测使每位患者的替代抗凝治疗成本从 39,616 美元降至 12,799 美元。用于建模的可用数据存在局限性，因此应谨慎对待这些估计。
使用按需检测可能会对临床和成本结果产生积极影响。
