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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Thrombophilia testing in people with venous thromboembolism: systematic review and cost-effectiveness analysis

EL Simpson, MD Stevenson, A Rawdin, and D Papaioannou.

Review published: 2009.

Link to full article: [Journal publisher]

CRD summary

This review concluded that there were no eligible studies for the assessment of thrombophilia testing compared with no testing following a venous thrombotic event. Despite some concern over language bias and review methods at the selection stage, this conclusion reflects the results of an extensive search and is likely to be reliable.

Authors' objectives

To assess the clinical and cost-effectiveness of thrombophilia testing compared with no testing following a venous thrombotic event, in the management of thrombosis.

Searching

The following databases were searched without language restriction from inception to September or November 2006: MEDLINE, EMBASE, CINAHL, DARE, NHS EED, HTA database, the Cochrane Library, Science Citation Index, Web of Science, BIOSIS Previews, National Research Register, Current Controlled Trials, Centre for Reviews and Dissemination (CRD) ongoing reviews and Research Findings Register. Search terms were reported. Only studies reported in English were eligible for inclusion.

Study selection

Studies of any design which assessed thrombophilia testing in people with venous thrombosis confirmed by objective testing were eligible for inclusion. Studies were required to use a panel of diagnostic tests and the subsequent anticoagulation management compared with current standard care (risk assessment based on personal and family history). Outcomes to be assessed were venous thrombotic events, mortality, adverse effects of anticoagulation treatment, health-related quality of life and anticoagulation management measures. Studies of thrombophilia while patients were on warfarin, thrombosis in pregnancy or pregnancy complications associated with thrombophilia, or thrombosis related to temporary risk factors such as surgery or oestrogen therapy were excluded from the review. Also excluded were case-finding studies where there was no personal history of thrombosis.

One reviewer selected the studies for the review.

Assessment of study quality

A validity assessment using the criteria of the Centre for Reviews and Dissemination (CRD) for randomised controlled trials (RCTs) and the Downs and Black checklist for other study designs was planned but not implemented due to the lack of included studies.

Data extraction

Data extraction using a standardised form was planned but not implemented due to the lack of included studies.

Methods of synthesis

No synthesis was possible.

Results of the review

No studies were included in the review.

Cost information

Thrombophilia testing in patients with pulmonary embolism had a cost per quality-adjusted life-year of less than £20,000. In patients with previous deep vein thrombosis the cost was below £20,000 per quality-adjusted life-year for men aged 69 years or less and women aged 49 years or less. These results are subject to great uncertainty.

Authors' conclusions

No clinical studies were identified that met the inclusion criteria of the review.

CRD commentary

The review question and inclusion criteria were broad. The search was extensive and included unpublished material but, as the authors acknowledged, the restriction of the inclusion criteria to English language reports may have potentially excluded relevant studies. The authors did not take steps designed to reduce bias and error in the selection of studies for the review. Appropriate procedures were planned for the assessment of validity and the extraction of data. In the absence of any included studies, it is clear that the authors' conclusions and recommendations for further research were appropriate. They are also likely to be reliable, despite some minor concern over the issue of language bias and rigorous review methodology at the selection stage.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further research on the sensitivity and specificity of tests for specific types of thrombophilia is required. Studies comparing patients with venous thromboembolism tested for thrombophilia with those whose risk assessment was based on personal and family thrombosis history (the current standard of care) would also be useful.

Funding

NIHR HTA Programme.

Bibliographic details

Simpson E L, Stevenson M D, Rawdin A, Papaioannou D. Thrombophilia testing in people with venous thromboembolism: systematic review and cost-effectiveness analysis. Health Technology Assessment 2009; 13(2): 1-114. [PubMed: 19080721]

Indexing Status

Subject indexing assigned by NLM

MeSH

Chronic Disease; Cost-Benefit Analysis; Decision Trees; Electric Stimulation Therapy /adverse effects /economics /methods; Evidence-Based Medicine; Failed Back Surgery Syndrome /therapy; Great Britain; Humans; Ischemia /complications; Markov Chains; Neuralgia /therapy; Pain /etiology /psychology; Pain Management; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Reflex Sympathetic Dystrophy /therapy; Research Design; Sensitivity and Specificity; Spinal Cord; Technology Assessment, Biomedical; Treatment Outcome

AccessionNumber

12009102368

Database entry date

24/06/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19080721

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