ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost-effective analysis.
ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost-effective analysis.
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DOI：
10.1111/trf.14230
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发表时间：
2017-11
期刊：
影响因子：
2.9
通讯作者：
Pham HP
中科院分区：
文献类型：
--
作者：
Kim CH;Simmons SC;Williams LA III;Staley EM;Zheng XL;Pham HP
ADAMTS 13检测可区分血栓性血小板减少性紫癜（TTP）和其他血栓性微血管病（TMA）。PLASMIC评分有助于确定ADAMTS 13缺陷的预试验概率。由于这两种测试的固有局限性，以及潜在的不良反应和不必要的治疗费用，我们进行了成本效益分析（CEA），调查将住院ADAMTS 13测试和/或PLASMIC评分纳入我们的临床实践的好处。创建CEA模型，以比较TMA患者的4种情况，使用内部与发送ADAMTS 13测定，使用PLASMIC评分进行或不进行既往风险分层。模型参数，包括概率和成本，从医学文献中收集，除了ADAMTS 13发送和内部测试，从我们的机构数据中获得。如果只考虑成本，对于具有中-高风险PLASMIC评分的患者，内部ADAMTS 13检测是最便宜的选择（4，732美元/患者）。如果以避免的死亡人数来评估有效性，则发送ADAMTS 13测试是最有效的。考虑到成本/效果比，在具有中-高风险PLASMIC评分的患者中进行内部ADAMTS 13检测是最佳选择，其次是没有PLASMIC评分的内部ADAMTS 13检测。在临床表现为TMAs的患者中，进行住院ADAMTS 13检测以及时确定TTP的诊断似乎具有成本效益。利用PLASMIC评分提高了ADAMTS 13内部测试的成本效益。我们的研究结果表明，拥有快速可靠的内部ADAMTS 13测试的好处，特别是在三级医疗中心。
ADAMTS13 test distinguishes thrombotic thrombocytopenic purpura (TTP) from other thrombotic microangiopathies (TMAs). PLASMIC score helps determine the pretest probability of ADAMTS13 deficiency. Due to inherent limitations of both tests, and potential adverse effects and cost of unnecessary treatments, we performed a cost-effectiveness analysis (CEA) investigating the benefits of incorporating an in-hospital ADAMTS13 test and/or PLASMIC score into our clinical practice. A CEA model was created to compare 4 scenarios for a patient with TMAs, utilizing either an in-house vs. send-out ADAMTS13 assay with or without prior risk stratification using PLASMIC scoring. Model parameters, including probabilities and costs, were gathered from the medical literature, except for the ADAMTS13 send-out and in-house tests, which were obtained from our institutional data. If only the cost is considered, in-house ADAMTS13 test for patients with intermediate-high risk PLASMIC score is the least expensive option ($4,732/patient). If effectiveness is assessed as measured by the number of averted deaths, send-out ADAMTS13 test is the most effective. Considering the cost/effectiveness ratio, the in-house ADAMTS13 test in patients with intermediate-high risk PLASMIC score is the best option, followed by the in-house ADAMTS13 test without the PLASMIC score. In patients with clinical presentations of TMAs, having an in-hospital ADAMTS13 test to promptly establish the diagnosis of TTP appears to be cost-effective. Utilizing the PLASMIC score increases the cost-effectiveness of the in-house ADAMTS13 test. Our findings indicate the benefit of having a rapid and reliable in-house ADAMTS13 test, especially in the tertiary medical center.
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