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Thromb Haemost 2000; 84(05): 752-757
DOI: 10.1055/s-0037-1614110
Review Article
Schattauer GmbH

Extended Anticoagulation for Prevention of Recurrent Venous Thromboembolism in Carriers of Factor V Leiden

Cost-effectiveness Analysis
Monia Marchetti
1   From the Laboratory of Medical Informatics, Pavia, Italy
,
Angela Pistorio
2   Laboratory of Biostatistics and Epidemiology, IRCCS Policlinico S. Matteo, Pavia, Italy
,
Giovanni Barosi
1   From the Laboratory of Medical Informatics, Pavia, Italy
› Author Affiliations
Further Information

Publication History

Received 14 February 2000

Accepted after resubmission 21 June 2000

Publication Date:
13 December 2017 (online)

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Summary

There is much debate over the appropriateness of prescribing prolonged anticoagulation to heterozygous carriers of factor V Leiden suffering a first episode of deep vein thrombosis (DVT). We, thus used meta-analysis to estimate from six eligible studies the summary odds-ratio of recurrent DVT in carriers of factor V Leiden versus noncarriers: 1.36 (CI, 1.05–1.78). After that, we used a decision model to compare lifelong costs and benefits of 6 months standard anticoagulation with those of screening for carriers of factor V Leiden and extending for 2 years their anticoagulation. Screening was a cost-effective strategy, since it provided 2 additional quality-adjusted days of life per patient at the cost of $ 12,833 per quality-adjusted year of life saved, as compared to standard management. However, screening was not costeffective in patients who were predicted to incur fatal bleeding at a rate higher than 0.34% per year or recurrent DVT at a rate lower than 9% in the first 2 years. The screening policy was cost-saving if restricted to patients with idiopathic DVT and compliant to warfarin therapy.

Key words

Venous thromboembolism - cost-effectiveness analysis - decision analysis - factor V Leiden
 

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