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Fertil Steril. 1999 Oct;72(4):646-51.

Screening for factor V Leiden mutation before prescribing combination oral contraceptives.

Author information

1
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pennsylvania 15213-3180, USA. mcreinin@mail.magee.edu

Abstract

OBJECTIVE:

To evaluate the cost-effectiveness of screening for factor V Leiden mutation in women in the United States who use combination oral contraceptives.

DESIGN:

Cost-effectiveness analysis.

SETTING:

A national research reference laboratory, a university medical center, and an academic health center managed care organization.

PATIENT(S):

Women of reproductive age in the United States.

INTERVENTION(S):

Baseline risk estimates of venous thromboembolic disease in the general population and in carriers of factor V Leiden mutation were calculated using available data.

MAIN OUTCOME MEASURE(S):

The number of women who would require factor V Leiden testing and the cost of identifying this cohort to prevent one death caused by venous thromboembolic disease before prescribing combination oral contraceptives.

RESULT(S):

To prevent one venous thromboembolic death attributable to the use of oral contraceptives in women with factor V Leiden mutation, >92,000 carriers would need to be identified and stopped from using these pills. The estimated charge to prevent this one death would exceed $300 million. If the price of testing were discounted to 34.5% of current charges, the cost still would be between $105 million and $130 million.

CONCLUSION(S):

Screening for factor V Leiden mutation before prescribing combination oral contraceptives is not a cost-effective use of U.S. health care dollars. The best and most cost-effective screening tool we have is taking a thorough personal and family history related to venous thromboembolic events.

PMID:
10521103
[Indexed for MEDLINE]

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