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Thrombophilia testing in a tertiary paediatric hospital: Indications, outcomes and appropriateness
Aryanto Sudarmana1, Paul Monagle1,2,3
1Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Insights
Thrombophilia testing in children is often inappropriate, costing over $100,000 and impacting management in only a third of cases. Improving testing practices could save significant hospital costs.
Area of Science:
- Pediatric Hematology
- Clinical Pathology
- Medical Economics
Background:
- The link between inherited thrombophilia and childhood thrombotic disease remains unclear.
- The clinical utility and cost-effectiveness of thrombophilia testing in pediatric patients are debated.
Purpose of the Study:
- To evaluate the appropriateness of thrombophilia testing in a tertiary pediatric hospital.
- To determine the financial implications of inappropriate thrombophilia test utilization.
Main Methods:
- Retrospective analysis of thrombophilia tests ordered between 2011-2013 at the Royal Children's Hospital.
- Data collection included patient demographics, clinical details, test indications, and impact on management.
Main Results:
- 3867 tests were performed on 613 patients, costing $102,579.
- Testing was frequently used for non-thrombosis indications (e.g., liver transplant, stroke protocol, heparin anticoagulation).
- Only 70% of tests were deemed appropriate, with some departments exceeding 50% inappropriate usage.
Conclusions:
- Optimizing thrombophilia testing could save over $29,000 every 3 years at the hospital.
- While improvements are needed, other high-volume, low-cost tests may offer greater cost-saving potential.
Aim:
The association between inherited thrombophilia and thrombotic disease in children is unclear. As a result, whether expensive thrombophilia tests are indicated in children is a contentious issue. This retrospective study aimed to assess the appropriateness of thrombophilia testing and the associated cost of inappropriate testing at a tertiary paediatric hospital.
Methods:
We conducted a search for thrombophilia tests ordered at the Royal Children's Hospital between 1 January 2011 and 31 December 2013. Using pathology and clinical records, we collected data relating to demographics, clinical data, indications, requesting departments and impact on patient management.
Results:
Over the 3-year period, 3867 tests were ordered for 613 patients costing the hospital $102 579. Tests were most commonly ordered by gastroenterology on patients receiving liver transplants, by neurology as part of the stroke protocol, and by cardiology and cardiac surgery for patients anticoagulated on heparin infusions. Testing for thrombosis-related indications was relatively uncommon. Thrombophilia testing only directly affected management in one-third of patients. Overall, 70% of thrombophilia tests ordered were considered appropriate. However, some departments were found to have rates of inappropriate testing in excess of 50%.
Conclusion:
With improvements in thrombophilia testing practices at the Royal Children's Hospital AU$29 645.40 could be saved over 3 years. While there are improvements to be made in this area, in the overall context of the hospital's pathology testing budget, review of other areas such as inappropriate use of low-cost, high-volume tests may be of greater value in reducing the cost of pathology testing.
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