A Review Of Economic Evaluations Considering Screening Interventions For The Risk Assessment Of Venous Thromboembolism In Women Considering Combined Oral Contraceptives

OBJECTIVES: Use of combined oral contraceptives (COCs) in women increases the risk of venous thromboembolism (VTE), which can have a major impact on quality of life. VTE is also associated with an increase in healthcare costs. Our aim was to systematically review cost-effectiveness analyses (CEAs) considering any screening for risk of VTE in women using COCs, to assess the quality of these studies, and to summarize the results. METHODS: A search strategy was performed in MEDLINE, Embase, the Centre for Review and Dissemination (CRD) database including the Economic Evaluation Database from the UK National Health Service, and Cochrane reviews. TWo reviewers independently screened and determined the final articles, and a third reviewer resolved any discrepancies. Consolidated Health Economic Evaluation Reporting Standards were used to assess the quality of reporting in terms of perspective, effectiveness measures, model structure, cost, time-horizon and discounting. RESULTS: Four publications (three from Europe, one from the United States) were deemed suitable to be included in the review and to undergo full assessment. According to current criteria, none of the studies were of sufficient quality of reporting. Incremental cost-effectiveness ratio was above accepted thresholds of (-40,000 to e50,000.The studies varied in terms of type of costs assessed, country settings, model assumptions and uncertainty around input parameters. Key drivers of CEAs were sensitivity and specificity of the test, incidence rate of VTE, relative risk of prophylaxis, and costs of the test. CONCLUSIONS: Universal screening strategies for risk of VTE in regards to COCs may not be cost-effective according to accepted cost-effectiveness thresholds within Europe. However, modifications to the targeted population and cost could potentially make screening for VTE economically viable. Further cost-effectiveness studies that explore individual screening based on standardized economic methods are required to improve decision making for this pertinent issue within personalized medicine.