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

M. Marchetti, S. Quaglini, G. Barosi

Research output: Contribution to journalArticlepeer-review

Abstract

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

Original languageEnglish
Pages (from-to)365-372
Number of pages8
JournalQJM
Volume94
Issue number7
Publication statusPublished - 2001

ASJC Scopus subject areas

  • Medicine(all)

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