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Screening for factor V Leiden mutation before prescribing combination oral contraceptives
M D Creinin1, R Lisman, R C Strickler
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pennsylvania 15213-3180, USA. mcreinin@mail.magee.edu
Fertility and Sterility
|October 16, 1999
Summary
Screening women for the factor V Leiden mutation before prescribing oral contraceptives is not cost-effective. A thorough personal and family history is a more effective screening method for preventing venous thromboembolic events.
Area of Science:
- Pharmacoeconomics
- Genetics
- Thrombosis
Background:
- Oral contraceptives increase venous thromboembolic disease (VTE) risk, particularly in women with factor V Leiden mutation.
- Factor V Leiden is a common genetic risk factor for VTE.
Purpose of the Study:
- To assess the cost-effectiveness of screening for factor V Leiden mutation in U.S. women using combination oral contraceptives.
- To determine the economic viability of genetic screening versus traditional risk assessment.
Main Methods:
- A cost-effectiveness analysis was performed.
- Baseline VTE risk estimates for the general population and factor V Leiden carriers were calculated.
- The number of women needing testing and the cost to prevent one VTE death were modeled.
Main Results:
- Preventing one VTE death requires identifying over 92,000 factor V Leiden carriers and discontinuing their oral contraceptive use.
- The estimated cost to prevent one VTE death exceeds $300 million, even with discounted testing costs.
Conclusions:
- Routine screening for factor V Leiden mutation before prescribing oral contraceptives is not a cost-effective strategy in the U.S.
- Taking a detailed personal and family history of VTE events is the most cost-effective screening approach.