Pharmacoeconomic analysis for diagnosis and treatment of suspected heparin-induced thrombocytopenia
Thomson J, To L, Peters M, and Kalus J. Pharmacoeconomic analysis for diagnosis and treatment of suspected heparin-induced thrombocytopenia Crit Care Med 2018; 46:256.
Critical Care Medicine
Learning Objectives: Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition that is associated with a 30-75% increased risk of thrombosis. The variation in interpretation of laboratory data and clinical diagnosis of HIT has led to different management approaches for HIT, which contributes to significant healthcare cost. The aim of this project was to evaluate the economic impact from treatment of patients with suspected HIT in order to identify cost reduction opportunities. Methods: Single-center, retrospective analysis of patients evaluated for HIT at Henry Ford Hospital between December 2013 and August 2016. Data was collected for adult patients with a platelet-factor 4 enzyme linked immunosorbent assay (PF4-ELISA) result during the study period. Cost (composite of hospital, drug, and laboratory costs) was evaluated for patients with a low optical density (OD < 1.0) compared to those with a high result (OD ≥ 1.0). Predictive value of the Warkentin 4T score and the PF4-ELISA was determined when confirmatory serotonin-release assay (SRA) result was available. Results: A total of 119 patients were included in the analysis. Only 92 patients had a confirmatory SRA. Baseline characteristic were similar between the groups. The total cost of HIT therapy was near double in the high OD group ($33,023 vs. $18.342, p < 0.00001). Patients in the high OD group were also more likely to have an intermediate risk 4T score compared to higher frequency of low risk in the low OD group (4 vs. 2, p = 0.009). Sensitivity and specificity of the 4T score and PF4-ELISA were similar to previous literature. A cost-minimization analysis identified $30,000 per patient of cost savings with standardization of the approach to patients with suspected HIT. Conclusions: There are significantly higher hospital expenditures for patients with a higher OD, which is largely driven by cost of hospital stay; however, not all patients with an OD ≥ 1.0 were diagnosed with HIT and confusion with interpretation of lab assays persists. Our study gives merit to the establishment of a more streamlined and systematic process for diagnosis and treatment of HIT to reduce hospital expenditures.