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an Economist Intelligence Unit business healthcare

Bazian investigates diagnostic tests for coagulation

March 17th 2016

This month we published an article in the peer-reviewed journal Thrombosis Research. The publication was based on a research project we undertook for a client, Instrumentation Laboratory. The project looked at tests used to diagnose people with heparin-induced thrombocytopenia (HIT). HIT is a condition which happens when people receiving heparin have a reaction to the heparin that causes the number of tiny blood cells known as platelets to drop. This rare reaction can lead to blood clots forming inside blood vessels and can lead to death.

We researched the most commonly used diagnostic tests. We compared the performance of the tests in terms of accuracy and speed. We also looked at the clinical impact of improved diagnosis performance and speed for HIT with regards to patient complications, safety and satisfaction. The most commonly used diagnostic pathway is a two stage process that can take several days to complete. Therefore, when HIT is suspected, many doctors speculatively switch their patients onto alternative anticoagulants, which cost much more than heparin, because they do not want to risk their patient's condition deteriorating while they wait for test results. So another factor we had to consider during our research was the cost impact of improved diagnosis.

To understand this, we did a literature review looking for evidence of the performance of different tests and the outcomes for people with HIT that goes untreated. We also performed a survey and in-depth interviews with practitioners to find out their key challenges and to fill in gaps for data not reported in the literature. This approach allowed us to design several diagnostic scenarios and to evaluate the impact of using different diagnostic tests within different pathways.

We found that on-demand tests may drive positive effects on clinical and cost outcomes. Such tests would potentially allow diagnosis to be made more quickly and to save on costs, as only those with confirmed HIT would be switched into more expensive alternative anticoagulants. The full publication and the findings can be found here.