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Using thrombophilia testing to determine anticoagulation duration in pediatric thrombosis is not cost-effective

Sarah H O'Brien1, Kenneth J Smith

  • 1Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA. sarah.obrien@nationwidechildrens.org

The Journal of Pediatrics
|March 28, 2009
PubMed

Insights

For children experiencing a first blood clot, 3 months of anticoagulation without thrombophilia testing is the most cost-effective strategy. Universal thrombophilia testing is not cost-effective for determining treatment duration.

Area of Science:

  • Pediatric thrombosis
  • Health economics
  • Clinical decision-making

Background:

  • Thrombophilia testing in children with thrombosis is common but its cost-effectiveness is debated.
  • Determining optimal anticoagulation duration is crucial for patient outcomes and resource allocation.

Purpose of the Study:

  • To evaluate the cost-effectiveness of different thrombophilia testing and anticoagulation strategies in pediatric patients with a first episode of thrombosis.
  • To inform clinical guidelines regarding thrombophilia testing in this population.

Main Methods:

  • A 2-year Markov model was developed to compare three strategies: no testing with 3-month anticoagulation, no testing with 6-month anticoagulation, and testing with treatment duration based on results.
  • Clinical probabilities were estimated from literature searches, and quality-of-life and cost data were sourced from published data.

Main Results:

  • The least expensive strategy was 3 months of anticoagulation without testing ($7900 per patient), which was also the most effective (1.74 quality-adjusted life-years).
  • This strategy was more effective by 0.01 to 0.03 quality-adjusted life-years compared to other strategies.
  • While cost-utility ratios were sensitive to hospitalization and medication costs, the 3-month no-testing approach remained the preferred choice.

Conclusions:

  • Universal thrombophilia testing is not cost-effective when solely used to guide anticoagulation duration in children with a first thrombosis.
  • A comprehensive thrombophilia panel should not be a routine response for every deep venous thrombosis diagnosis in pediatric patients.
Abstract

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