Department of Economics, Seattle University, 901 12th Avenue, Seattle, WA, 98122, USA.
College of Nursing, Seattle University, 901 12th Avenue, Seattle, WA, 98122, USA.
Appl Health Econ Health Policy. 2017 Oct;15(5):583-595. doi: 10.1007/s40258-017-0318-x.
Combined oral contraceptives (COCs) increase the risk of venous thromboembolism (VTE), particularly among women with inherited clotting disorders. The World Health Organization classifies combined hormonal contraception as an "unacceptable health risk" for women with thrombogenic mutations but advises against universal thrombophilia screening before prescribing COCs given the low prevalence of thrombophilia and high screening costs.
Through the lens of lifetime costs and benefits, this paper systematically and critically reviews all published economic evaluations of thrombophilia screening prior to prescribing COCs.
We searched relevant databases for economic evaluations of thrombophilia screening before prescribing COCs. After extracting the key study characteristics and economic variables, we evaluated each article using the Quality of Health Economic Studies (QHES) and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) instruments.
Seven economic evaluations of thrombophilia screening before prescribing COCs met our inclusion criteria. Only the two economic evaluations focusing exclusively on selective screening exceeded the 75-point threshold for high-quality economic studies based on the QHES instrument, whereas only one of these exceeded the 85% CHEERS threshold. Only three of the seven economic evaluations performed sensitivity analysis on key parameters. Most studies underestimated the benefits of thrombophilia screening by comparing one-time costs of genetic screening against benefits per person-year, thus implicitly assuming a 1-year duration of COC use, neglecting the long-term implications of VTE and/or neglecting the lifetime benefits of awareness of inherited thrombophilia.
Our review highlights the lack of methodologically rigorous economic evaluations of universal thrombophilia screening before prescribing COCs.
口服避孕药（COC）会增加静脉血栓栓塞（VTE）的风险，尤其是在有遗传性凝血障碍的女性中。世界卫生组织将联合激素避孕法列为有血栓形成突变的女性的“不可接受的健康风险”，但鉴于血栓形成倾向的低患病率和高筛查成本，建议在开具 COC 之前不要进行普遍的血栓形成倾向筛查。
通过终生成本和收益的视角，本文系统地批判性地回顾了所有关于在开具 COC 之前进行血栓形成倾向筛查的经济评估。
我们搜索了相关数据库，以获取在开具 COC 之前进行血栓形成倾向筛查的经济评估。在提取关键研究特征和经济变量后，我们使用卫生经济研究质量（QHES）和卫生保健经济评估报告标准（CHEERS）工具对每篇文章进行评估。
符合纳入标准的有七项关于在开具 COC 之前进行血栓形成倾向筛查的经济评估。仅基于 QHES 工具，专注于选择性筛查的两项经济评估超过了高质量经济研究的 75 分阈值，而这两项中的仅有一项超过了 85% CHEERS 阈值。只有三项经济评估对关键参数进行了敏感性分析。大多数研究通过将基因筛查的一次性成本与每人每年的收益进行比较，从而低估了血栓形成倾向筛查的收益，因此隐含地假设 COC 使用期限为 1 年，忽略了 VTE 的长期影响和/或忽略了遗传性血栓形成倾向的终生收益。
我们的综述突出表明，在开具 COC 之前进行普遍的血栓形成倾向筛查的经济评估缺乏方法学严谨性。
