Diagnostic Testing Approaches for Activated Protein C Resistance and Factor V Leiden

Author:

Perez Botero Juliana1,Majerus Julie A.2,Strege Ann K.2,Johnson Ryan D.34,Chen Dong2,Pruthi Rajiv K.12

Affiliation:

1. From the Division of Hematology, Department of Medicine

2. Special Coagulation and Special Coagulation DNA Diagnostic Laboratories, Department of Laboratory Medicine and Pathology, and

3. The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; and

4. OptumLabs, Cambridge, MA

Abstract

Abstract Objectives To analyze the economic impact of testing for activated protein C resistance (APC-R) due to factor V Leiden (FVL) mutation with APC-R with reflexive FVL genotyping (algorithmic approach) or genotyping alone. Methods OptumLabs Data Warehouse (OLDW) data were used to assess testing approaches. Insurance claims for APC-R and FVL in 2013 were compared with the Mayo Clinic database. Centers for Medicare & Medicaid Services diagnostic fee schedules were used to assign costs. Results Of 19.3 million OLDW-covered individuals, 74,242 (0.385%) received 75,608 tests: APC-R, 2,265 (2.9%); FVL genotyping, 70,619 (90.1%); and both APC-R and FVL, 2,724 (7.0%). In total, 1,317 tests were performed at Mayo Clinic: APC-R with reflex FVL (1,256; 95.4%) and FVL alone (61; 4.6%). Costs per evaluated individual and per total population (person/year) in OLDW and algorithmic approach were $83.77 vs $36.38 and $0.32 vs $0.14, respectively. Conclusions The cost-optimized algorithmic approach reduces health care costs.

Publisher

Oxford University Press (OUP)

Subject

General Medicine

Reference26 articles.

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