Effectiveness and costs of a stepwise versus an all-in-one approach to diagnose mild bleeding disorders
© 2022 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:200 |
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| Enthalten in: |
British journal of haematology - 200(2023), 6 vom: 15. März, Seite 792-801 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Heubel-Moenen, Floor C J I [VerfasserIn] |
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| Links: |
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| Themen: |
Algorithms |
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| Anmerkungen: |
Date Completed 07.03.2023 Date Revised 14.03.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/bjh.18570 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM349572518 |
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| 520 | |a © 2022 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd. | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a coagulation disorders | |
| 650 | 4 | |a cost-effectiveness analysis | |
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| 700 | 1 | |a Verhezen, Paul W M |e verfasserin |4 aut | |
| 700 | 1 | |a Wetzels, Rick J H |e verfasserin |4 aut | |
| 700 | 1 | |a van Oerle, Rene G M |e verfasserin |4 aut | |
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| 700 | 1 | |a Beckers, Erik A M |e verfasserin |4 aut | |
| 700 | 1 | |a Joore, Manuela A |e verfasserin |4 aut | |
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