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- Title
Potential impact of a delayed ADAMTS13 result in the treatment of thrombotic microangiopathy: an economic analysis.
- Authors
Kim, Chong H.; Simmons, Sierra C.; Wattar, Sarah F.; Azad, Ameneh; Pham, Huy P.
- Abstract
Background: A pre‐plasma exchange ADAMTS13 measurement differentiates thrombotic thrombocytopenic purpura (TTP) from other forms of thrombotic microangiopathy (TMA). Given that many hospitals do not perform the ADAMTS13 assay in‐house and that the turnaround time (TAT) differs among reference laboratories, we performed an analysis investigating the potential impact of a delay in obtaining the results on the healthcare system. Methods: An economic model was developed to estimate the impact of a delay in obtaining the pretreatment ADAMTS13 results on patients admitted with TMA with cost (US dollars) as the primary outcome. Incremental cost‐effectiveness ratio (ICER) as a composite outcome was calculated from both cost and life days [LDs], an effectiveness surrogate marker. Model parameters were gathered from the medical literature, except for the institutional cost of the ADAMTS13 test. Results: In patients with TMA, during the 6‐day study period, the incremental cost to the healthcare system ranged from approximately $4155 to $5123 for every 1‐day delay in obtaining the pre‐exchange ADAMTS13 results with virtually no change in the effectiveness marker. The ICER composite outcome established the cost‐effectiveness of having a fast TAT for pre‐exchange ADAMTS13 results. Probabilistic sensitivity analyses also confirmed the robustness of the model. Conclusions: In patients with clinical presentations of TMAs, having a rapid TAT for pre‐exchange ADAMTS13 measurement appeared to be cost‐effective. If testing cannot be performed in‐house, then our findings support the necessity of contracting with a reference laboratory that can reliably provide the result, preferably within 1 day of admission.
- Subjects
ECONOMIC research; ECONOMIC models; THROMBOTIC microangiopathies; MEDICAL care costs; TURNAROUND time; MEDICAL literature
- Publication
Vox Sanguinis, 2020, Vol 115, Issue 5, p433
- ISSN
0042-9007
- Publication type
Article
- DOI
10.1111/vox.12912