Effectiveness and costs of a stepwise versus an all-in-one approach to diagnose mild bleeding disorders.
Br J Haematol
; 200(6): 792-801, 2023 03.
Article
in En
| MEDLINE
| ID: mdl-36444397
ABSTRACT
The diagnostic work-up of patients referred to the haematologist for bleeding evaluation is performed in a stepwise way bleeding history and results of screening laboratory tests guide further diagnostic evaluation. This can be ineffective, time-consuming and burdensome for patients. To improve this strategy, the initial laboratory investigation can be extended. In a model-based approach, effectiveness and costs of a conventional stepwise versus a newly proposed all-in-one diagnostic approach for bleeding evaluation were evaluated and compared, using data from an observational patient cohort study, including adult patients referred for bleeding evaluation. In the all-in-one approach, specialized platelet function tests, coagulation factors, and fibrinolysis tests were included in the initial investigation. Final diagnosis, hospital resource use and costs and patient burden were compared. A total of 150 patients were included. Compared to the stepwise approach, in the all-in-one approach, 19 additional patients reached a diagnosis and patient burden was lower, but total costs per patient were higher [359, 95% bootstrapped confidence interval (BCI) 283-518, p = 0.001]. For bleeding evaluation of patients referred to the haematologist, an all-in-one diagnostic approach has a higher diagnostic yield and reduces patient burden, at a higher cost. This raises the question what costs justify the diagnosis of a bleeding disorder and a less burdensome diagnostic strategy.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Blood Coagulation Disorders
/
Hemorrhagic Disorders
Type of study:
Diagnostic_studies
/
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
Limits:
Adult
/
Humans
Language:
En
Journal:
Br J Haematol
Year:
2023
Type:
Article
Affiliation country:
Netherlands