Summary
There is much debate over the appropriateness of prescribing prolonged anticoagulation
to heterozygous carriers of factor V Leiden suffering a first episode of deep vein
thrombosis (DVT). We, thus used meta-analysis to estimate from six eligible studies
the summary odds-ratio of recurrent DVT in carriers of factor V Leiden versus noncarriers:
1.36 (CI, 1.05–1.78). After that, we used a decision model to compare lifelong costs
and benefits of 6 months standard anticoagulation with those of screening for carriers
of factor V Leiden and extending for 2 years their anticoagulation. Screening was
a cost-effective strategy, since it provided 2 additional quality-adjusted days of
life per patient at the cost of $ 12,833 per quality-adjusted year of life saved,
as compared to standard management. However, screening was not costeffective in patients
who were predicted to incur fatal bleeding at a rate higher than 0.34% per year or
recurrent DVT at a rate lower than 9% in the first 2 years. The screening policy was
cost-saving if restricted to patients with idiopathic DVT and compliant to warfarin
therapy.
Key words
Venous thromboembolism - cost-effectiveness analysis - decision analysis - factor
V Leiden
