Activated protein C resistance assay when applied in the general population

Area of Science:

• Medical diagnostics
• Genetics
• Health economics

Background:

• Factor V Leiden is a common genetic risk factor for venous thromboembolism.
• Activated protein C resistance (APCR) is a laboratory test used to detect factor V Leiden.
• Accurate diagnosis is crucial for risk stratification and preventative strategies.

Purpose of the Study:

• To evaluate the predictive values of APCR testing in identifying women who are carriers of factor V Leiden.
• To assess the cost-effectiveness of using APCR assays for factor V Leiden screening in a population with a 2% prevalence.

Main Methods:

• Retrospective analysis of diagnostic test performance.
• Calculation of positive predictive values for APCR.
• Cost-effectiveness analysis based on preventing thromboembolic deaths.

Main Results:

• In a population with 2% factor V Leiden prevalence, the positive predictive value of APCR was 44%.
• The estimated cost to prevent one thromboembolic death using this assay was $44,180,000.
• These figures indicate a low predictive accuracy and high cost associated with the APCR assay in this context.

Conclusions:

• The activated protein C resistance assay is not a cost-effective tool for ruling out factor V Leiden carriers in populations with low prevalence.
• Alternative or complementary diagnostic strategies may be more appropriate for efficient screening.
• Further research into cost-effective methods for identifying thrombophilia risk is warranted.