Gaddh Manila, Cheng En, Elsebaie Maha A T, Bodó Imre
Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States.
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States.
TH Open. 2020 Aug 9;4(3):e153-e162. doi: 10.1055/s-0040-1714334. eCollection 2020 Jul.
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. 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. 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. 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.
检测遗传性和获得性血栓形成倾向会增加静脉血栓栓塞症（VTE）患者的护理成本，尽管检测结果可能不会影响患者的治疗管理。 这是一项于2015年1月至12月在埃默里大学医院进行的单中心回顾性研究，目的是（1）确定VTE患者的血栓形成倾向检测模式，（2）研究血栓形成倾向检测结果对临床决策的影响，以及（3）确定VTE患者血栓形成倾向检测的直接成本。 在266名符合条件的患者中，189名（71%）接受了检测；51名（26.9%）检测呈阳性，检测结果对32名（16.9%）接受检测的患者的治疗管理产生了影响。接受检测的患者更可能年龄小于40岁（30.9%对18.2%）、有过既往流产史（9.0%对0%）或已知有高凝家族史（24.9%对10.4%），且发生诱因性VTE的可能性较小（37%对79.2%）。检测的最常见血栓形成倾向为抗磷脂综合征（60.1%）、凝血因子V莱顿突变（59.7%）和凝血酶原基因突变（57.5%）。血栓形成倾向检测的直接成本为每位患者2364.32美元，诊断出1例阳性结果的成本为12331.55美元，每位受治疗管理影响的患者成本为19653.41美元。 我们注意到患者选择和检测项目存在显著差异，检测结果在患者管理中的利用率较低，但VTE患者的血栓形成倾向检测成本较高。鉴于指南提倡选择性使用血栓形成倾向检测并关注检测结果对患者管理的潜在影响，我们建议在机构层面采取措施改善检测医嘱行为。
