Sarah Caton1, Elly O'Brien1, Annie Jullien Pannelay2, Robert G Cook1. 1. Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom. 2. Bazian Ltd, The Economist Intelligence Unit, 20 Cabot Square, London E14 4QW, United Kingdom. Electronic address: anniepannelay@eiu.com.
Abstract
BACKGROUND: The diagnostic work-up for heparin induced thrombocytopenia (HIT) can take several days. Consequently patients may be speculatively switched onto replacement anticoagulant therapy before a diagnosis is confirmed. On-demand immunoassay diagnostic testing enables timely treatment decisions, based on test results. OBJECTIVE: To estimate the clinical and cost impact of the use of on-demand versus batched diagnostic tests for HIT. METHODS: Literature was reviewed to identify test performance, clinical and cost data. Semi-structured interviews (n=4) and a survey (n=90) provided insights into current practice and challenges. Flow diagram models were developed to estimate the potential impact of on-demand testing. RESULTS: Modelling estimated more HIT-related outcomes for patients maintained on heparin whilst awaiting test results and patients switched onto replacement anticoagulant therapy awaiting test results, compared with on-demand testing and treatment based on the results. The budget impact model estimated that on-demand testing reduced replacement anticoagulant therapy costs from $39,616 to $12,799 per patient. There are limitations to the data available to inform modelling and the estimates should be treated with caution. CONCLUSIONS: Using on-demand testing may drive positive effects on clinical and cost outcomes.
BACKGROUND: The diagnostic work-up for heparin induced thrombocytopenia (HIT) can take several days. Consequently patients may be speculatively switched onto replacement anticoagulant therapy before a diagnosis is confirmed. On-demand immunoassay diagnostic testing enables timely treatment decisions, based on test results. OBJECTIVE: To estimate the clinical and cost impact of the use of on-demand versus batched diagnostic tests for HIT. METHODS: Literature was reviewed to identify test performance, clinical and cost data. Semi-structured interviews (n=4) and a survey (n=90) provided insights into current practice and challenges. Flow diagram models were developed to estimate the potential impact of on-demand testing. RESULTS: Modelling estimated more HIT-related outcomes for patients maintained on heparin whilst awaiting test results and patients switched onto replacement anticoagulant therapy awaiting test results, compared with on-demand testing and treatment based on the results. The budget impact model estimated that on-demand testing reduced replacement anticoagulant therapy costs from $39,616 to $12,799 per patient. There are limitations to the data available to inform modelling and the estimates should be treated with caution. CONCLUSIONS: Using on-demand testing may drive positive effects on clinical and cost outcomes.
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